Anti-Atelier Effect of 5-mg Prasugrel in Low Body Weight Patients Similar to Standard Dose in Normal Weight Patients

Among low body weight patients with stable coronary artery disease, the efficacy of a 5-mg maintenance dose of prasugrel is non-inferior to a 10-mg maintenance dose in higher body weight patients, according to the FEATHER clinical trial. The results, published on Oct. 17 in the Journal of the American College of Cardiology, suggest that a lower maintenance dose of prasugrel could provide a better risk-benefit balance for LBW patients and support current prasugrel dosing recommendations.

The FEATHER trial was a blinded, randomized, crossover comparison of 5- and 10-mg maintenance doses of prasugrel and 75-mg doses of clopidogrel, given in three 12-day intervals to 72 LBW (<60 kg) and high body-weight (HBW) (≥60 kg) aspirin-treated patients with stable coronary artery disease. The study assessed maximal platelet aggregation using light transmission aggregometry, VerifyNow P2Y12 and vasodilator-associated stimulated phosphoprotein (VASL) level measured before and after each 12-day treatment period.

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In LBW patients, the 5-mg dose of prasugrel was found non-inferior to the 10-mg dose in HBW patients. There was no loss in the antiplatelet effect with the lower dose in patients weighing less than 60 kg. Similar levels of platelet inhibition were observed with the low dose in LBW patients as were observed with the high dose in heavier patients. When compared to clopidogrel, the 5-mg dose of prasugrel in LBW patients produced greater reductions in platelet activation across all platelet function measurements. LBW patients experienced more mild bleeding complications, such as contusions and hematomas, when compared to heavier patients, but less than has been observed in previous studies.

According to the study authors, "prasugrel 5-mg maintenance treatment in low body-weight patients resulted in platelet inhibition that was non-inferior compared with that of a prasugrel 10-mg maintenance dose in high body-weight patients and achieved active metabolite exposures in a range in which efficacy was maintained and the risk of bleeding lower than in the TRITON-TIMI 38 study."


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