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[메디파나뉴스]NEW subanalysis published in 2019 AHA prompts doctors to select


[메디파나뉴스 = 박으뜸 기자] The American Heart Association (AHA 2019), which is being held in Philadelphia, USA, received additional points for & # 39; high school students & # 39; which proved the safety of the cardiovascular system (CV) and showed high effects.

In the case of PCSK9 inhibitors, the status is increasing due to the recommendations of the European Heart Association (ESC) and the Association of Arterial Sclerosis (EAS).

Meanwhile, Amgen's Lepata (Ebolokumab) has provided positive data for the treatment of high-risk heart attacks.

In general, patients who have had a heart attack are at greater risk for the next cardiovascular event within a year. Lepata has done much to reduce CV events.

Heart attack patients treated with the combination of lepata and statin at one year had a 25% reduction in CV events compared to statin alone. This includes any heart attack, death or stroke.

Fourier clinical trials involving 27,564 patients with a history of atherosclerotic cardiovascular disease (myocardial infarction, stroke or peripheral arterial disease: ASCVD, atherosclerotic cardiovascular disease) showed that treatment with lepata and statin in one year. A 15% reduction in CV risk has been reported in elderly patients.

Lepata has already shown that LDL-C, which has been intensively reduced in several clinical trials, is beneficial for high-risk patients.

Amgen is planning the first large-scale study, cvMOBIUS, to see how lipid management of PCSK9 inhibitors via lepata affects CV results. The clinic follows 5 years after 8,500 adults who presented CVAD within 12 months of treatment with PCSK9 inhibitors.

However, as the & # 39; inclisiran & # 39; of the drug company appeared on the market as 'RNA interference therapy (RNAi)' which prevented PCSK9 production, PCSK9 inhibitors faced a new competitor. Inclycyran third-phase data released last September reported a 54% reduction in LDL-C compared to statin therapy.

AstraZeneca introduced the oral double antiplatelet drug “ brillanta & # 39; (component name: ticagrelor) and the SGLT-2 inhibitor “ pocigar (dapagliflozin) & # 39; & # 39 ;.

Bryllita reaffirmed its efficacy in patients with acute coronary artery stratification (ACS) by reducing associated bleeding alone compared to aspirin combination. AstraZeneca has been following ACS patients for at least one stent for more than 12 months.

These data are a follow-up analysis of Brillianta's clinical trial in Twilight, which was superior to the combination with aspirin in CV events involving all-cause deaths, heart attacks and strokes.

In February, Brillianta, through the THEMIS trial, used a combination of Brillita and aspirin in patients with coronary artery disease (CAD) with type 2 diabetes with no history of heart attack or stroke. The risk was reduced by 10%.

In preliminary subanalysis of patients with a history of percutaneous coronary intervention (PCI) widening the obstructed or narrowed coronary arteries, Brillinta-Aspirin combination therapy was associated with cardiovascular death, heart failure. Relative risk of stroke was reduced by 15%. .

Posigar has experimental data showing that patients with or without type 2 diabetes can reduce the risk of heart failure.

In the Dapa-HF study, pocigar reduced the risk of cardiovascular disease by 27% in patients without diabetes. The reduction in CV risk in patients with diabetes was 25%. Forty-five percent of patients with reduced cardiac output coefficients (HFrEF) who participated in the Dapa-HF study were diagnosed with type 2 diabetes and the remaining 55% did not.

Based only on cardiovascular death, Posigar reduced the risk of diabetics by 21% and the risk of those who did not by 15%. The risk of heart attack in diabetic and non-diabetic patients was reduced by 23% and 38%.

Pocigar received an FDA Fasttrack designation last September, reducing the risk of heart failure and cardiovascular death in HFrEF patients by 26% compared to patients receiving standardized heart failure treatment.

Novartis treatment for heart failure, Entresto (Sakubitril / Valsartan), has been disappointing in the PARAGON-HF clinical study in patients with preserved ejection fraction (HFpEF) heart failure. Reduced cardiovascular mortality and hospitalization for heart failure by 13%, but did not reach statistical significance.

However, Novartis, in a subanalysis of the Paragon-HF and Paradigm-HF clinical trials in AHA, reported that heart failure patients with cardiac output below 57% responded more strongly to Entresto than patients with higher ejection rates.

A cardiac output rate of less than 40% is defined as a & quot; decrease & quot; and over 40% is defined as 'preservation' no treatments currently approved. Entresto has already been approved in patients with reduced cardiac output rates to reduce the risk of death and hospitalization for CV.

And in a separate subanalysis of the Paragon-HF trial, Entresto outperformed men in female heart patients with conserved ejection rates.

Novartis found that the overall CV event in patients with a left ventricular ejection rate below the median of 57% was reduced by 22%, with a 27.5% reduction in female patients. Thus, Novartis emphasized that while Entresto has not achieved its primary goal, the drug still has evidence to show its potential.

Bayer Jarelto (Rivaroxaban), on the other hand, was evaluated as a pioneer of NOAC and led to many of the early indications, but the greater bleeding compared to aspirin in Jarretto-treated patients after percutaneous aortic valve treatment (TAVR). The cause of mortality is still being answered.

This comes from the Galileo clinical study, announced in October 2018. Patients received aspirin three months after taking Jarelto and aspirin twice a week after TAVR. The patient continued to take Jarelto alone for an intermediate period of 17 months.

However, the COMPASS study in patients with coronary artery disease (CAD) or peripheral arterial disease (PAD) ended about one year before the planned schedule, as the overwhelming efficacy of Jarrelto-Aspirin combination therapy was confirmed. .

According to the study, the combination of Jarelto 2.5 mg and low-dose aspirin therapy (one day) reduced the combined risk of death from stroke, myocardial infarction and cardiovascular disease by 24% compared to aspirin in monotherapy. The relative risk of risk is also reduced by 42% and 18% respectively.

<© 2019 메디파나뉴스, 무단 전재 및 배포금지>Medipana News, The Korean Medical Center News

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