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18Â¥2013-09-10 18:04:01
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Strengths The first novel anticoagulant to secure approval for stroke prevention in atrial fibrillation (AF), entering the US market in November 2010 No requirement for anticoagulation monitoring and dose adjustment, and no food effect In the RE-LY trial in AF, Pradaxa showed comparable to superior efficacy in stroke prevention, compared with warfarin, with equal to lower bleeding risk A subgroup analysis from RE-LY showed that Pradaxa 150 mg bid reduced the rate of stroke by 35% compared with well-controlled warfarin, irrespective of a patient's stroke risk Comparable to Lovenox in the prevention of major venous thromboembolism (VTE) and VTE-related mortality after both knee and hip replacement, according to RE-NOVATE data Equal efficacy to well-controlled warfarin in the treatment of acute VTE, but with a 37% reduction in major or clinically relevant bleeding risk over 6 months, according to RECOVER data |
2Â¥2013-04-03 10:38:46
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williamxiang: ½ð±Ò+5 2013-04-03 10:47:53
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williamxiang: ½ð±Ò+5 2013-04-03 10:47:53
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Weaknesses A superiority claim over warfarin in stroke prevention was rejected for inclusion in the label by the FDA A 110 mg doseage was not approved for use in patients at higher bleeding risk A higher risk of myocardial infarction was seen in RE-LY Twice daily dosing, compared with once daily for Xarelto Not approved in the US for VTE prevention post-surgery, unlike Xarelto which was approved in July 2011 Has faced some safety concerns, and the label was updated to mandate renal testing in high-risk patients Associated with a 6% rate of major gastrointestinal hemorrhage during each patient year on treatment Other gastrointestinal side effects, including dyspepsia, nausea and gastritis, are increased compared with warfarin (35% vs 24%) Current lack of antidote Very short half-life once removed from specially designed desiccant-containing packaging |
3Â¥2013-04-03 10:41:12
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Opportunities Approval in AF opens up a blockbuster market, and Pradaxa could garner a greater share of the market in the near term due to its first mover advantage Pradaxa could be viewed as superior to Xarelto given Xarelto's lack of superiority to warfarin on an intent-to-treat basis seen in the ROCKET AF trial Despite the proven efficacy of warfarin in stroke prevention, it has a number of limitations, such as an increased risk of bleeding and the need for patient monitoring and dose adjustment, which has created an unmet need for safe and effective alternatives Approval in acute coronary syndrome (ACS); phase III trials in this setting began in December 2007 Development of competitor Eliquis in ACS was discontinued following high rates of bleeding in trials High cost and considerable copay required for Pradaxa may fade as insurers realize potential savings from increased avoidance of ischemic events and hospitalization AF is the most common sustained cardiac rhythm disturbance, and prevalence increases with age Up to 60% of cases of AF are caused by hypertension or coronary artery disease, which are increasing in prevalence in most Western societies ACS is the leading cause of death in the US and one of the most prevalent non-communicable diseases in the world |
4Â¥2013-04-03 10:53:35














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