Trial results of Pradaxa® vs ASA in ESUS published in NEJM
First Phase III randomised clinical trial to compare dabigatran etexilate and acetylsalicylic acid (ASA)
No significant difference in recurrent stroke prevention after ESUS
Dabigatran showed no significant difference in major bleeding
INGELHEIM, GERMANY--(Business Wire / Korea Newswire) May 16, 2019 -- Boehringer Ingelheim today announced full results from the RE-SPECT ESUS® trial, a Phase III randomised, double-blind study investigating the efficacy and safety of Pradaxa® (dabigatran etexilate) versus acetylsalicylic acid (ASA) in preventing recurrent stroke in patients with embolic stroke of undetermined source (ESUS). The results were published in the New England Journal of Medicine (NEJM).
The trial did not meet its primary endpoint, which was to show a clinically significant difference between dabigatran etexilate and ASA on reducing the risk of a recurrent stroke among post-stroke patients with ESUS. However, a post-hoc analysis showed a treatment effect emerged in favour of dabigatran after one year. The safety results from the trial demonstrated that the risk of major bleeding was not significantly different between dabigatran etexilate and ASA.1 A comparable low risk for the most serious bleeding outcomes, such as intracranial haemorrhage, was shown.
As the first ever comparative trial to investigate dabigatran etexilate versus ASA, the results add to the wealth of evidence supporting the established safety profile of dabigatran etexilate, which has already been demonstrated in its approved indications in the extensive RE-VOLUTION® clinical trial and registry programme.[2-24]
“The results from RE-SPECT ESUS provide highly interesting information, showing that dabigatran had a similar low risk of major bleeding compared to ASA in this high-risk population of post-stroke patients. This clearly reaffirms the positive risk-benefit profile of dabigatran,” said Dr Waheed Jamal, Corporate Vice President, Head of CardioMetabolic Medicine, Boehringer Ingelheim.
ESUS is a type of cryptogenic stroke, which is when an ischaemic stroke has an unknown cause. A stroke is classified as an ESUS when other potential diagnoses have been ruled out.[25,26] Overall, one in six ischaemic strokes are classified as ESUS. Following an ESUS, most patients are treated with anti-platelet therapy, such as ASA; however, one in three go on to have a recurrent stroke within five years.
Pradaxa is not approved in any country for patients with ESUS.
Randomised, double-blind, evaluation in secondary stroke prevention comparing the efficacy and safety of the oral thrombin inhibitor dabigatran etexilate vs. acetylsalicylic acid (ASA) in patients with embolic stroke of undetermined source (RE-SPECT ESUS®)
RE-SPECT ESUS® was a Phase III, double-blind trial of dabigatran vs ASA for secondary stroke prevention in patients with ESUS and involved 5,390 patients from more than 40 countries. Patients were randomised to receive dabigatran etexilate 150 mg BID, adjusted to 110mg BID for patients above 75 years or with impaired renal function, and a placebo matching ASA 100 mg or ASA 100 mg and a placebo matching dabigatran etexilate. The primary endpoint of the trial was to show a clinically significant difference between dabigatran etexilate and ASA on the risk of a recurrent stroke among post-stroke patients with ESUS.
Please click on the following link for ‘Notes to Editors’ and ‘References’: http://www.boehringer-ingelheim.com/press-release/noac-vs-asa-esus-trial-results-published-nejm
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