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NICE backs use of AZ's Brilique as maintenance therapy

Drug to be used with asprin as treatment for heart attack patients

AstraZeneca headquarters

AstraZeneca's antiplatelet drug Brilique can be used alongside aspirin as a long-term maintenance therapy in patients who have had a heart attack, according to NICE. 

The UK agency has concluded in draft guidance that giving Brilique (ticagrelor) for a longer period is a cost-effective use of NHS resources and can help prevent further heart attacks or stroke. Brilique costs around £1 per day, according to the agency.

A 90mg dose Brilique given for 12 months after a heart attack is already backed by NICE, but the new draft guidance would allow patients to receive a lower 60mg dose for up to three years. A similar verdict was reached by NICE's German counterpart IQWiG earlier this year.

The value of longer-term use in heart attack patients was revealed in the PEGASUS trial, which showed Brilinta plus low-dose aspirin was significantly more effective than placebo plus aspirin at reducing the risk of dying from cardiovascular causes, having another heart attack, or having a stroke.

NICE's health technology evaluation centre director Prof Carole Longson said Brilique that despite the availability of effective secondary prevention treatments, "as many as a quarter of people who have had a heart attack go on to have another heart attack or stroke - often with devastating consequences". 

"Fear of recurrence can have significant negative impact on a person's quality of life," she added.

The positive verdict is a boost for AZ, as Brilique (known as Brilinta in the US) is a key growth driver for the company with a sales target of $3.5bn by 2023. In the first half of the year sales rose 48% to reach $395m. 

In March the company suffered a setback to its plans after Brilique failed to show efficacy in a stroke trial, with analysts suggesting the $3.5bn target will be tough to achieve without a stroke indication. 

The drug remains in development for other new indications however - including peripheral arterial disease and sickle cell disease - and was recently named as a treatment of choice in US guidelines on the treatment of acute coronary syndromes (ACS). It is also in a large-scale trial in patients with coronary artery disease (CAD) and type 2 diabetes.

Article by
Phil Taylor

12th August 2016

From: Research, Regulatory

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