Author + information
- Oliver I. Brown, MBBS, MSc∗ (, )
- Jennifer A. Rossington, MBChB and
- Angela Hoye, MBChB, PhD
- ↵∗Department of Academic Cardiology, University of Hull, Hull York Medical School, Castle Hill Hospital, Castle Road, Daisy Building, Kingston Upon Hull, East Yorkshire HU16 5JQ, United Kingdom
We read with great interest the results of the recently published meta-analysis by Lau et al. (1), along with its insightful accompanying editorial. First, we would like to thank the authors for highlighting the importance of the under-representation of women in clinical trials, an issue that, as a community, we all should be trying to address. In addition, we welcome the collaborative effort of the original trial investigators to perform this analysis.
However, we were surprised to see that neither the PHILO trial (2) nor the PRASFIT ACS (Prasugrel compared with Clopidogrel For Japanese patients with ACS undergoing PCI) trial (3) were identified for inclusion in their analysis. The PHILO and PRASFIT-ACS trials were multicenter double-blind, randomized control trials of potent P2Y12 inhibitors performed in East Asian patients undergoing percutaneous coronary intervention in the setting of acute coronary syndrome. Both PHILO and PRASFIT-ACS had a primary composite endpoint of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke and compared ticagrelor and prasugrel to clopidogrel, respectively. Although the results of PRASFIT-ACS were similar to those of this current analysis, PHILO did not demonstrate a significant benefit of ticagrelor compared to clopidogrel and, in fact, favored clopidogrel in men (reported hazard ratio of 1.88; 95% confidence interval: 1.02 to 3.46).
As the authors are aware, the benefit of ticagrelor in East Asian patients, particularly in Japan, has been drawn into question due to the results of PHILO and the low recruitment number of East Asian patients in the PLATO (Platelet Inhibition and Clinical Outcomes) trial (4). Therefore, inclusion of the PHILO trial in this analysis would not only have added significant value to the paper but ensured more caution was taken in the interpretation of its results.
Please note: Dr. Rossington and Dr. Hoye have received research grants from AstraZeneca. Dr. Brown has reported that he has no relationships relevant to the contents of this paper to disclose. Deepak L. Bhatt, MD, MPH, served as Guest Editor-in-Chief for this paper. Stephen Ellis, MD, served as Guest Editor for this paper.
- 2017 American College of Cardiology Foundation
- Lau E.S.,
- Braunwald E.,
- Murphy S.A.,
- et al.
- Goto S.,
- Huang C.-H.,
- Park S.-J.,
- et al.
- Serebruany V.L.,
- Tomek A.,
- Pya Y.,
- et al.