Proton pump inhibitors do not interfere with benefits of Plavix, Effient: study

The combined use of proton pump inhibitors (PPIs) with sanofi-aventis and Bristol-Myers Squibb's Plavix (clopidogrel), or with Eli Lilly and Daiichi Sankyo's Effient (prasugrel), did not interfere with the clinical benefits of the antiplatelet agents in patients after an acute coronary syndrome (ACS), according to an analysis of study data to be published in The Lancet. Researchers noted that the results contrast with prior findings from other studies, and remarked that these latest data "do not support the need to avoid concomitant use of patients receiving clopidogrel or prasugrel."

The analysis was based on data from the randomised TRITON-TIMI 38 trial that enrolled over 13 600 patients who suffered a heart attack or unstable angina, and who were given either Plavix or Effient. The study authors evaluated the effects of PPIs in the trial, and they found that for patients who took these medications in combination with Plavix or Effient there was no increased risk of cardiovascular events, compared with patients who took Plavix or Effient alone.

A previous analysis of medical and pharmacy claims data by Medco indicated that among patients who had undergone a percutaneous coronary intervention, those who were being treated with Plavix plus a PPI had a 50-percent increase in the risk of having a major cardiovascular event, compared with those who took Plavix alone.

The author of the Medco study, Robert Epstein, explained that the overall health of the patients involved in the studies may have played a role in producing contrasting results. He suggested that the new analysis involved healthier patients who were not in a "real-world setting." The lead investigator of the latest study, Michelle O'Donoghue, noted that PPIs are often given to more seriously ill patients, which might explain why they experience more adverse events. However, she said such differences were adjusted for in the research. The authors stated that a thorough clinical trial is needed to clearly understand how PPI use affects treatment with antiplatelet drugs.

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