Heart patients in England and Wales offered more choice of therapies as NICE extends recommendations for prasugrel

Revised guidance from the National Institute for Health and Care Excellence (NICE), recommends once-daily, oral antiplatelet prasugrel (Efient®), in combination with aspirin, as a cost-effective option when compared to generic clopidogrel, for a wider group of acute coronary syndrome (ACS) patients having primary or delayed percutaneous coronary intervention (PCI).¹

Prasugrel, will now also be available for preventing atherothrombotic events for adults with ACS with unstable angina (UA) or non-ST-segment elevation myocardial infarction (NSTEMI) having PCI.1 This latest recommendation builds on initial NICE guidance in October 2009, which recommended prasugrel for ACS patients having PCI when immediate primary PCI for ST-segment elevation myocardial infarction (STEMI) is necessary, or when stent thrombosis has occurred during clopidogrel treatment, or if the patient has diabetes mellitus.²

Dr Tim Kinnaird, Consultant Cardiologist at University College Cardiff, who acted as an adviser to the NICE appraisal committee said: “This recommendation is very welcome as it offers clinicians a wider choice to protect ACS patients against atherothrombotic events when undergoing PCI. It is important that all suitable treatment options are available so the most appropriate clinical decision to manage patients can be made particularly for higher-risk patients with other co-morbidities, such as diabetes. Having another cost effective option for UA and NSTEMI patients undergoing PCI is particularly relevant to the UK, as this patient population is generally treated poorly compared to STEMI patients undergoing PCI.”

The NICE Assessment Group reported that the TRITON-TIMI 38 trial (comparing prasugrel with clopidogrel in 13,608 patients with moderate- to high-risk ACS scheduled to have PCI), was robustly designed and of strong methodological quality. For patients in the core clinical cohort (younger than 75 years, weighing 60 kg or more and with no history of stroke or transient ischaemic attack), prasugrel demonstrated a clinically significant and robust reduction in the primary end point compared with clopidogrel.¹

Dr Jean-Michel Cosséry, Vice President & Managing Director – Lilly UK and Northern Europe said: “We welcome this recognition from NICE that prasugrel is a cost effective option when compared to generic clopidogrel. The extended guidance means that both STEMI and NSTEMI patients can benefit from this effective treatment.”

“We welcome this latest recommendation from NICE and the assessment is based on the strong clinical trial data for prasugrel demonstrating efficacy across all subgroups,” said Dr Simon Clough, Managing Director of Daiichi Sankyo UK. “We are glad that NSTEMI and UA patients in England and Wales will have another therapy option and this latest decision now puts England and Wales in line with the health and policy recommendations for prasugrel in other European countries.”

References

1. NICE. Prasugrel with percutaneous coronary intervention for treating acute coronary syndromes (review of technology appraisal guidance 182). Technology appraisal 317. London: NICE; July 2014. (www.nice.org.uk)
2. NICE. Prasugrel for the treatment of acute coronary syndromes with percutaneous coronary intervention Technology appraisal 182. London: NICE; October 2009. (www.nice.org.uk)