Ticagrelor–aspirin more effective in patients with normal vs impaired renal function

Patients with normal, instead of impaired, renal function tend to benefit more from the combination therapy ticagrelor plus aspirin than clopidogrel plus aspirin, reveals a study.

A post hoc analysis of a multicentre, randomized, double-blind, placebo-controlled trial (CHANCE-2) in 202 centres in China was conducted to explore the effect of renal function on the efficacy and safety of ticagrelor–aspirin versus clopidogrel–aspirin treatment.

The researchers assessed renal function by levels of estimated glomerular filtration rate (eGFR), with the primary efficacy and safety outcomes being recurrent stroke and severe or moderate bleeding within 90 days, respectively.

A total of 6,378 patients were analysed, of which 4,050 (63.5 percent) had normal (eGFR ≥90 mL/min/1.73 m²), 2,010 (31.5 percent) had mildly decreased (eGFR 60 to 89 mL/min/1.73 m²), and 318 (5.0 percent) had moderately to severely decreased (eGFR <60 mL/min/1.73 m²) renal function.

The differences in recurrent stroke between ticagrelor‒aspirin and clopidogrel‒aspirin for normal, mildly decreased, and moderately to severely decreased renal function were −2.8 percentage points (95 percent confidence interval [CI], −4.4 to −1.3; hazard ratio [HR], 0.63, 95 percent CI, 0.49 to 0.81), −0.2 percentage point (95 percent CI, −2.4 to 2.0; HR, 0.98, 95 percent CI, 0.69 to 1.39), and 3.7 percentage points (95 percent CI, −2.3 to 10.1; HR, 1.31, 95 percent CI, 0.48 to 3.55), respectively.

No significant difference was observed in the rates of severe or moderate bleeding by treatment assignments across eGFR categories.

In terms of the limitations of this study, “[r]enal function was only evaluated by using eGFR, and the proportion of patients with severely decreased renal function was low,” according to the researchers.