New ESC Guidelines Recommend BRILIQUE (ticagrelor) in all Moderate-To-High Risk Patients With Non-ST Elevation Acute Coronary Syndromes

Paris (ots/PRNewswire) -

- This release is not intended for US media

Ticagrelor Recommended for Medically & Invasively Managed

NSTE-ACS Patients Regardless of Prior Treatment with Clopidogrel

AstraZeneca today announced BRILIQUE (ticagrelor), a new oral
antiplatelet medicine, received a Class I recommendation (level of
evidence B) from the European Society of Cardiology (ESC) in the
revised "Guidelines for Management of Acute Coronary Syndromes (ACS)
in patients presenting without persistent ST-segment elevation."

In these 2011 guidelines, ticagrelor is recommended for all non-ST
elevation ACS patients at moderate-to-high risk of ischaemic events,
regardless of initial treatment strategy and including those
pre-treated with clopidogrel (which should be discontinued when
ticagrelor is commenced) (Class 1, level of evidence B). In addition,
the guidelines recommend ticagrelor be considered for initiation or
resumption following coronary artery bypass graft (CABG) surgery as
soon as it is considered safe (Class IIa, level of evidence B).

"The inclusion of ticagrelor in the new NSTE-ACS ESC guidelines is
another important step toward improving ACS patient care in the EU,"
said Professor Lars Wallentin, co-primary investigator of the PLATO
study and Professor of Cardiology and Research Director at the
Uppsala University, Sweden.

The ESC guidelines as well as marketing authorisation in the EU
for ticagrelor were based on a review of the ticagrelor clinical
programme, including results from PLATO (A Study of PLATelet
Inhibition and Patient Outcomes), which established the superiority
of ticagrelor over clopidogrel, and showed that treating 54 ACS
patients with ticagrelor instead of clopidogrel for one year
prevented one atherothrombotic event and treating 91 patients
prevented one cardiovascular (CV) death, with no increase in overall
major/fatal bleeding over the course of one year of treatment (11.6%
for ticagrelor versus 11.2% for clopidogrel, p=0.43). However,
non-CABG major bleeding was more common with ticagrelor versus
clopidogrel (4.5% vs. 3.8%, p=0.03).

On 6 December 2010, the European Commission granted marketing
authorisation to ticagrelor, co-administered with acetylsalicylic
acid (ASA) (maintenance dose 75-150mg daily), for the prevention of
atherothrombotic events in adult patients with ACS (unstable angina,
NSTEMI, or STEMI), including patients managed medically and those who
are managed with percutaneous coronary intervention (PCI) or CABG.
This decision followed advance incorporation of the medicine into
ESC's 2010 Guidelines for Myocardial Revascularisation [http://www.e
scardio.org/guidelines-surveys/esc-guidelines/GuidelinesDocuments/gui
delines-revasc-FT.pdf ] in August.

These updates to the 2011 Guidelines for Management of Acute
Coronary Syndromes (ACS) in patients presenting without persistent
ST-segment elevation [http://www.escardio.org/guidelines-surveys/esc
-guidelines/GuidelinesDocuments/Guidelines-NSTE-ACS-FT.pdf ] have
been featured in an ESC press release [http://www.escardio.org/about
/press/press-releases/esc11-paris/Pages/guidelines-acute-coronary-syn
dromes.aspx ] and presented at an ESC press conference on Monday,
29th August in Paris, France, while simultaneously being published in
the European Heart Journal. Ticagrelor is also recommended for
treatment of ACS in the Canadian Cardiovascular Society Guidelines [
http://download.journals.elsevierhealth.com/pdfs/journals/0828-282X/P
IIS0828282X10000310.pdf ] .

NOTES TO EDITORS

ABOUT ESC GUIDELINES

Class I indicates "evidence and/or general agreement that a given
treatment or procedure is bene?cial, useful, effective," while level
of evidence B signifies that this recommendation was based upon a
single randomised clinical trial. Class IIa indicates the "weight of
evidence/opinion is in favour of usefulness/efficacy."

ABOUT PLATO PLATO was a large (18,624 patients in 43 countries),
head-to-head patient outcomes study of ticagrelor versus clopidogrel,
both given in combination with aspirin and other standard therapy,
designed to establish whether ticagrelor could achieve a clinically
meaningful reduction in CV end points in ACS patients, above and
beyond those afforded by clopidogrel.

The study demonstrated that treatment with BRILIQUE led to a
greater reduction in the primary end point - a composite of CV death,
MI, or stroke - compared to patients who received clopidogrel [9.8%
vs. 11.7% at 12 months, 1.9% absolute risk reduction (ARR), 16%
relative risk reduction (RRR), 95% CI, 0.77 to 0.92, p<0.001]. The
difference in treatments was driven by CV death and MI with no
difference in stroke. In PLATO, the absolute difference in treatment
benefit versus clopidogrel was seen at 30 days and the Kaplan-Meier
survival curves continued to diverge throughout the 12-month
treatment period.

The study also demonstrated that treatment with BRILIQUE for 12
months was associated with a 21 percent RRR in CV death (4% vs. 5.1%,
1.1% ARR, p=0.001) and a 16 percent RRR in MI compared to clopidogrel
at 12 months (5.8% vs. 6.9%, 1.1% ARR, p<0.005).

The results of this analysis formed the basis of the
recommendation in all of the approved BRILIQUE labels that patients
taking BRILIQUE should also take a low-maintenance dose of aspirin
daily, unless specifically contraindicated.

About BRILIQUE (ticagrelor tablets)

BRILIQUE is an oral antiplatelet treatment for ACS. BRILIQUE is a
direct-acting P2Y12 receptor antagonist in a new chemical class
called cyclopentyltriazolopyrimidines (CPTPs). BRILIQUE is the first
reversibly-binding oral ADP receptor antagonist to be approved for
use in ACS.

BRILINTA has now been approved in 43 countries, including in the
European Union under the trade name BRILIQUE and in the United
States, Canada, Brazil, Malaysia and Macau under the trade name
BRILINTA. BRILINTA is currently under regulatory review in 49
countries, including Russia, India and China.

BRILINTA and BRILIQUE are trademarks of the AstraZeneca group of
companies. For detailed information regarding BRILINTA / BRILIQUE,
please refer to the local Summary of Product Characteristics.

About AstraZeneca

AstraZeneca is a global, innovation-driven biopharmaceutical
business with a primary focus on the discovery, development and
commercialisation of prescription medicines. As a leader in
gastrointestinal, cardiovascular, neuroscience, respiratory and
inflammation, oncology and infectious disease medicines, AstraZeneca
generated global revenues of US $33.3 billion in 2010. For more
information please visit: http://www.astrazeneca.com

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