VTE trial boost for Pfizer and BMS’ apixaban
Pfizer and Bristol-Myers Squibb’s oral anticoagulant apixaban has shown benefits over a standard injectable treatment for venous thromboembolism in a late-stage trial.
ADVANCE-3, a randomised, double-blind, multicenter, head-to-head phase III trial, showed apixaban was statistically superior to once-daily enoxaparin in reducing the incidence of venous thromboembolism (VTE) in patients undergoing elective total hip replacement surgery.
The goal of a superiority clinical trial is to determine if a new therapy is superior to an established therapy or placebo.
The study results also showed comparable rates of the composite of major and clinically relevant non-major bleeding, including surgical site bleeding, in patients treated with apixaban compared with those treated with enoxaparin (Sanofi-Aventis’ Lovenox).
Apixaban, which was submitted to US regulators for approval in October, is an oral, Factor Xa inhibitor, part of a class of agents being studied for their potential to prevent and treat blood clots in the veins and arteries.
They are all looking to replace warfarin, which has been the standard oral anti-clotting agent for both post-surgery prevention of VTE and atrial fibrillation prevention for over half a century. However, it interacts with many common medications and its use requires close GP monitoring.
Michael Rud Lassen from the Hoersholm Hospital in Copenhagen, Denmark was lead investigator for the study.
He said: “One of the major concerns for orthopaedic surgeons using oral anticoagulants for venous thromboembolism prevention in hip surgery is the significant risk of bleeding.
“We are encouraged by the ADVANCE-3 data, which demonstrated that apixaban provides more effective thromboprophylaxis without an increased risk of bleeding, when compared with enoxaparin, and has the advantages of oral administration, which is particularly beneficial once patients leave the hospital.”
VTE occurs in 40-60% of patients undergoing orthopaedic surgery who do not receive preventive care, making it a potentially ‘silent killer’ with few prophylactic options.
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