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Eliquis poised for new US approval

Published on 12/07/13 at 12:59pm
Eliquis image

Pfizer and Bristol-Myers Squibb have submitted their oral direct Factor Xa inhibitor Eliquis to the FDA to prevent deep vein thrombosis (DVT), which may lead to pulmonary embolism (PE), in patients who have had a hip or knee replaced.

The US regulator aims to make a decision by 15 March next year and, if approved in this indication, it will bring Eliquis (apixaban) onto a par with its status in Europe.

Taken twice a day, the drug targets a key blood-clotting protein to prevent clots forming.

The US supplemental new drug application is based on the ADVANCE-1, ADVANCE-2, and ADVANCE-3 trials, part of the EXPANSE clinical trial programme.

These trials randomised nearly 12,000 patients and assessed the safety and efficacy of Eliquis compared to Sanofi’s injectable Lovenox (enoxaparin).

DVT - a blood clot in a vein, usually in the leg - and PE - a clot which blocks one or more vessels in the lungs - are the two serious conditions which make up venous thromboembolism (VTE).

DVT causes pain but, more importantly, can progress to PE, which puts patients at risk of sudden death - and VTE happens in 40-60% of patients who have orthopedic surgery and do not receive preventive care.

Eliquis has found favour with regulators worldwide, and is approved to reduce the risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation (AF) in the US, Europe and Japan.

Earlier this year NICE said the drug can be used in AF patients on the NHS, a key commercial victory for the manufacturers.

Rivals such as Bayer’s Xarelto (rivaroxaban) and Boehringher Ingelheim’s Pradaxa (dabigatran) have already been approved as options by NICE.

Warfarin, the longstanding treatment which has been superseded by these newer drugs, needs regular monitoring, and has multiple interactions with food, alcohol and drugs that can cause further inconvenience for patients.

BMS and Pfizer say data from the ARISTOTLE and AVERROES studies suggests Eliquis is the only oral anticoagulant which shows superior risk reduction versus warfarin in stroke, major bleeding and all-cause death.

Adam Hill

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