Frank Trudo, MD, MBA, was recently appointed as VP, US Respiratory Medical Affairs at AstraZeneca.

You’ve had an interesting career in that you’ve been both a practicing pulmonologist seeing patients every day and a medical expert involved in drug development at AstraZeneca. Take me through your career path and what led you to your current role as VP of US Respiratory, Medical Affairs at AstraZeneca.

I decided to go into pulmonary medicine because I was interested in the multifaceted approach of the specialty across immunology, infectious disease, and oncology. I did my pulmonology specialty training at the University of Pennsylvania and then joined a practice. After 13 years as a practicing pulmonologist, I joined AstraZeneca in 2011 as the Associate Director of Clinical Research, Respiratory and Inflammation. My new role allowed me to pursue my desire to help patients on a different level by guiding the development of medications. Some of the most rewarding parts about working at AstraZeneca are being able to drive the science that helps advance patient care and being at the forefront of advancements in respiratory disease therapies. Over the course of my career, I’ve been involved in numerous projects, including several respiratory clinical trials.

Shifting to a more general treatment landscape question, what do you think is on the horizon for the Inhaled space?

It’s an exciting time in pulmonary medicine. We're recognizing that asthma and COPD are heterogeneous diseases

, meaning that there’s not just one type of inflammation driving these diseases.

Our aim at AstraZeneca is to transform asthma and COPD treatment through Inhaled combinations at the core of care, precision biologics for the unmet needs of specific patient populations, and scientific advancements in disease modification. Because of the complexity of respiratory disease, we need different treatment and device options for patients. The use of such targeted therapies, on top of controller medication, may lead to better asthma control and less exacerbation risks in patients with asthma.

Switching gears, one of the brands you worked on over the course of your career is SYMBICORT

(budesonide/formoterol fumarate dihydrate) Inhalation Aerosol.

Can you tell us about this treatment option? 

Combination products that contain an inhaled corticosteroid (ICS) and a long-acting beta

 adrenergic agonist (LABA), including SYMBICORT, are important medications for many patients

 and are a mainstay of inhalational therapy for asthma and COPD. AstraZeneca’s investment to fully explore indications in different populations shows our continued commitment to the respiratory space.

SYMBICORT is indicated for the treatment of asthma in patients 6 years of age and older.

 SYMBICORT should be used for patients not adequately controlled on a long-term asthma-control medication such as an ICS or whose disease warrants initiation of treatment with both an ICS and LABA.

SYMBICORT 160/4.5 µg is indicated for the maintenance treatment of airflow obstruction in patients with chronic obstructive pulmonary disease (COPD), including chronic bronchitis and/or emphysema, and to reduce COPD exacerbations.

SYMBICORT is not indicated for the relief of acute bronchospasm.

What are some milestones that speak to SYMBICORT’s evolution over the past several years? 

Last year was an important year of milestones for SYMBICORT because the FDA approved three label updates, made possible through several clinical trials. These included a safety/efficacy pediatric asthma indication trial in patients 6 to <12 years of age, a Phase 3b trial designed to support approval of the COPD exacerbation indication, which I helped design and execute, and a LABA post marketing safety study in asthma patients ≥12 years of age, which was part of an FDA-required class-wide clinical trial program conducted by manufacturers of ICS/LABAs that evaluated the risk of serious asthma-related events with ICS/LABA versus ICS alone.

In January 2017, SYMBICORT 80/4.5 µg was approved for the treatment of asthma in patients aged six up to 12 years. SYMBICORT 80/4.5 µg and 160/4.5 µg were already approved in the US to treat asthma in patients 12 years and older.

In September 2017, SYMBICORT 160/4.5 µg was approved for reducing exacerbations in patients with COPD. This added to the previously approved indication of maintenance treatment of airflow obstruction in patients with COPD including chronic bronchitis and/or emphysema.

In December 2017, the US Food and Drug Administration (FDA) approved updates to the labeling for all ICS/LABA products, including SYMBICORT. These updates included removal of the Boxed WARNING for serious asthma-related outcomes.

 The ICS/LABA labels all retain a Warning and Precaution related to an increased risk of asthma-related death when LABAs are used without an ICS in the treatment of asthma.

 These label updates were a result of an FDA review of 4 post-marketing LABA safety studies conducted with ICS/LABA products, including the study with SYMBICORT.

IMPORTANT SAFETY INFORMATION FOR SYMBICORT

-adrenergic agonists (LABA) as monotherapy (without inhaled corticosteroids [ICS]) for asthma is associated with an increased risk of asthma-related death. Available data from controlled clinical trials also suggest that use of LABA as monotherapy increases the risk of asthma-related hospitalization in pediatric and adolescent patients. These findings are considered a class effect of LABA. When LABA are used in fixed dose combination with ICS, data from large clinical trials do not show a significant increase in the risk of serious asthma-related events (hospitalizations, intubations, death) compared to ICS alone

SYMBICORT is NOT a rescue medication and does NOT replace fast-acting inhalers to treat acute symptoms

SYMBICORT should not be initiated in patients during rapidly deteriorating episodes of asthma or COPD

Patients who are receiving SYMBICORT should not use additional formoterol or other LABA for any reason

Localized infections of the mouth and pharynx with 

 has occurred in patients treated with SYMBICORT. Patients should rinse the mouth after inhalation of SYMBICORT

Lower respiratory tract infections, including pneumonia, have been reported following the administration of ICS

Due to possible immunosuppression, potential worsening of infections could occur. A more serious or even fatal course of chickenpox or measles can occur in susceptible patients

It is possible that systemic corticosteroid effects such as hypercorticism and adrenal suppression may occur, particularly at higher doses. Particular care is needed for patients who are transferred from systemically active corticosteroids to ICS. Deaths due to adrenal insufficiency have occurred in asthmatic patients during and after transfer from systemic corticosteroids to less systemically available ICS

Caution should be exercised when considering administration of SYMBICORT in patients on long-term ketoconazole and other known potent CYP3A4 inhibitors

As with other inhaled medications, paradoxical bronchospasm may occur with SYMBICORT

Immediate hypersensitivity reactions may occur, as demonstrated by cases of urticaria, angioedema, rash, and bronchospasm

Excessive beta-adrenergic stimulation has been associated with central nervous system and cardiovascular effects. SYMBICORT should be used with caution in patients with cardiovascular disorders, especially coronary insufficiency, cardiac arrhythmias, and hypertension

Long-term use of ICS may result in a decrease in bone mineral density (BMD). Since patients with COPD often have multiple risk factors for reduced BMD, assessment of BMD is recommended prior to initiating SYMBICORT and periodically thereafter

ICS may result in a reduction in growth velocity when administered to pediatric patients

Glaucoma, increased intraocular pressure, and cataracts have been reported following the administration of ICS, including budesonide, a component of SYMBICORT. Close monitoring is warranted in patients with a change in vision or history of increased intraocular pressure, glaucoma, or cataracts

In rare cases, patients on ICS may present with systemic eosinophilic conditions

SYMBICORT should be used with caution in patients with convulsive disorders, thyrotoxicosis, diabetes mellitus, ketoacidosis, and in patients who are unusually responsive to sympathomimetic amines

Beta-adrenergic agonist medications may produce hypokalemia and hyperglycemia in some patients

The most common adverse reactions ≥3% reported in asthma clinical trials included nasopharyngitis, headache, upper respiratory tract infection, pharyngolaryngeal pain, sinusitis, pharyngitis, rhinitis, influenza, back pain, nasal congestion, stomach discomfort, vomiting, and oral candidiasis

The most common adverse reactions ≥3% reported in COPD clinical trials included nasopharyngitis, oral candidiasis, bronchitis, sinusitis, and upper respiratory tract infection

SYMBICORT should be administered with caution to patients being treated with MAO inhibitors or tricyclic antidepressants, or within 2 weeks of discontinuation of such agents

Beta-blockers may not only block the pulmonary effect of beta-agonists, such as formoterol, but may produce severe bronchospasm in patients with asthma

ECG changes and/or hypokalemia associated with nonpotassium-sparing diuretics may worsen with concomitant beta-agonists. Use caution with the coadministration of SYMBICORT

SYMBICORT is indicated for the treatment of asthma in patients 6 years and older not adequately controlled on a long-term asthma-control medication such as an ICS or whose disease warrants initiation of treatment with both an ICS and LABA. (also see DOSAGE AND ADMINISTRATION).

SYMBICORT 160/4.5 is indicated for the maintenance treatment of airflow obstruction in patients with chronic obstructive pulmonary disease (COPD), including chronic bronchitis and/or emphysema, and to reduce COPD exacerbations.

SYMBICORT is NOT indicated for the relief of acute bronchospasm.

Heaney LG, McGarvey LP. Personalized medicine for asthma and chronic obstructive pulmonary disease. 

Global Initiative for Asthma. Global strategy for asthma management and prevention: 2018 report. 

https://ginasthma.org/2018-gina-report-global-strategy-for-asthma-management-and-prevention/

Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: 2018 report. 

SYMBICORT [package insert]. Wilmington, DE: AstraZeneca Pharmaceuticals LP; December 2017.

AstraZeneca Pharmaceuticals LP. US FDA updates SYMBICORT label with LABA safety class revisions and removes Boxed WARNING for serious asthma-related outcomes [press release]. 

https://www.astrazeneca-us.com/content/az-us/media/press-releases/2017/us-fda-updates-symbicort-label-with-laba-safety-class-revisions-and-removes-boxed-warning-for-serious-asthma-related-outcomes-12212017.html

. Published December 21, 2017. Accessed June 28, 2018

Articles

Frank Trudo, MD, MBA, was recently appointed as VP, US Respiratory, Medical Affairs, at AstraZeneca.

Q&A: From Practicing Pulmonologist to Researching Treatment Options

Current guidelines on the management of sepsis and septic shock indicate that appropriate routine microbiologic cultures (including blood) should be obtained before starting antimicrobial therapy. Because it could be days before clinicians gain access to the results of these cultures, most patients are empirically started on broad-spectrum therapies. Once the pathogen is identified and culture results are received, patients are then switched to more narrow therapies to which the pathogen is most susceptible.

Decreasing the time between suspected infection and appropriate narrow-spectrum therapy is key to improving patient outcomes—including mortality rates&mdash;and decreasing unwanted side-effects, such as 

18 hours to appropriate therapy has been identified as an independent determinant of post-infection intensive care unit (ICU) stay and the length stay of hospital.

Although there are several rapid diagnostic tests that address the delay in identification of organisms found in traditional methods, comparable tests for antibiotic susceptibility are lacking. In a presentation at the Society of Critical Care Medicine’s 47th Critical Care Conference in San Antonio, Texas, Ioana Chirca, MD, infectious diseases consultant, and head of the antimicrobial stewardship program (ASP) at University Hospital, in Augusta, Georgia, elaborated on this, stating, “There are several rapid diagnostic tests for bacteremia; it is likely your institution has one of them available. But most do not test antibiotics against live bacteria, and therefore do not provide phenotype antibiotic susceptibility information.”

 might change that. In fact, Chirca presented recent data that showed the system improved the time to pathogen identification and antibiotic susceptibility data by 41.2 hours when compared with conventional methods. Meaning that potentially, patients could be de-escalated almost 2 days sooner.

Furthermore, results from a 2017 clinical trial, which tested over 1800 specimens in 12 trial sites & reference sites, indicated that the system produced an ID result in about 1 hour and 24 minutes in 95% of runs. Time to AST result in 95% of runs was 7 hours and 5 minutes. Analysis of 515 positive blood cultures found that the Accelerate Pheno system’s rate of concordance with traditional methods was 98.3%. (See 

The system’s level of accuracy has allowed clinicians at Chirca’s hospital to de-escalate antibiotics earlier and with more confidence—even before minimal inhibitory concentration (MIC) information is known; however, according to Chica, “The machine calculates your MIC’s; it is pretty visual.” In the trial, the average time to identification occurred in 4.9 hours and MIC information was obtained in 10.9 hours. Comparatively, when using matrix-assisted laser desorption ionization-time of flight (MALDI-TOF), the average time to identification was 29.2 hours; with the Vitek system, MIC was obtained after 50.32 hours.

Chirca also shared anecdotal evidence from 3 clinical cases at her institution in which the system was effective in improving patient outcomes. Implementing this new system, in conjunction with the hospital’s antimicrobial stewardship program, has allowed antibiotic changes to happen faster, and with antibiotic optimization, comes better patient outcomes.

The clinical data she presented showed that from 2016 to 2017, the rate of multidrug-resistant organism (MDRO) infections in the ICU decreased 12% for methicillin-resistant 

 (MRSA) infections and 10.8% for vancomycin-resistant enterococci (VRE) infection after implementing the system.

Similarly, in inpatient settings, the rates of MRSA infections dropped from 50% and 49% in 2014 and 2015, and subsequently down to 41% in both 2016 and 2017. VRE infection rates reduced from 7.50%, 6.20%, and 6.50% in 2014, 2015, and 2016, respectively. A 4.20% reduction was seen in 2017.

Perhaps most importantly, the system also helped reduce the rates of sepsis mortality—from 14% in February 2017, to only 4% in September 2017, which is a remarkable decrease.

“The Accelerate Pheno system provided fast, reliable results while significantly improving turnaround time in blood culture diagnostics,” concluded Chirca, noting that as the implementation of ASPs in treating infections increases to comply with new Centers for Medicare & Medicaid Services 

, the importance of quick pathogen identification and susceptibility will increase as well.

________________________________________________

Gram-positive cocci organisms (71% of identified organisms)

In total, 137 cultures were excluded from analysis; 90 due to an inability to achieve identification (13.8% of 652 total collected); 11 which were polymicrobial (1.68%); 6 which showed no final growth (0.9%); and 30 which had incomplete data (4.6%).

Results from a 2017 clinical trial indicated that the Accelerate Pheno system produced an ID result in about 1 hour and 24 minutes in 95% of runs.

Faster Antibiotic Susceptibility Testing Results Improve Patient Care, Quality in the ICU

This article was sponsored by ACCELERATE.

After its approval by the US Food and Drug Administration (FDA) in 2017, the 

 system has been helping to revolutionize the treatment of infectious diseases in the United States.

The system, which is fully automated, allows physicians to identify pathogens in 90 minutes and then provides information on treatment options within a few more hours—including an ability to test the susceptibility of the said pathogen to multiple antibiotics. The system even provides a scoring scale to determine the best option for treatment.

All this is compared to the normal 2-day identification time and 3-day antibiotic testing time frames of conventional methods of testing. These require using a patient’s blood sample to grow bacteria and then identify the infection via biochemicals. Only after that process can antibiotics be tested.

Accelerate Pheno does this by recording video of the pathogen in questions’ growth, then utilizing computer algorithms to compare the growth patterns to its archive of patterns, something never before done in clinical diagnostics.

“We are one of the first in the world introducing this technology,” Eric R. Rosenbaum, MD, MPH, FCAP, an attending and clinical pathologist at the University of Arkansas for Medical Sciences (UAMS) and Arkansas Children's Hospital, as well as the medical director of the University’s Clinical Microbiology Laboratory, said in a 

. “The way it works is nothing short of revolutionary — part of a wider renaissance in clinical microbiology we are experiencing. But more importantly for our clinicians and patients, what it gives them is time.”

that even in the first few weeks of having access to the technology, the lab has seen great results. The device, he said, offers more than just new technology—it offers time to patients, which is invaluable in so many ways, especially in the infectious disease space. It could be the difference between exposing a patient to a therapy that could unnecessarily increase the risk of adverse events (AEs), as well as the use of higher cost medicines or an increased stay.

“It has already allowed us to reduce a patient’s exposure to zosyn and vancomycin, and de-escalate them onto ceftriaxone, which could be the difference maker in reducing their potential for AEs such as acute kidney injury," Rosenbaum said. "That decreases the length of stay—which starts to add up for the patient cost. If we can get rid of the bacterium, and do it without risk of other AEs, that’s a huge win for us.”

“Every one of these where we can make an intervention sooner is a win. I am really happy with what this brings to our immune suppressed patients and our healthy patients. I just wish more of them knew we had this technology," he added.

In addition to UAMS, the Peninsula Regional Medical Center (PRMC) in Maryland has also adopted the use of the instrument—and has also noted its successes. PRMC utilized the system before making it available to patients on December 4, 2017, in order to test its success and accuracy.

Beth Prouse, MS, MLS, ASCP, a clinical microbiologist at PRMC, noted in a 

 that while the PRMC was impressed with the speed of the tool, its precision was more pressing, and was an essential reason for its adoption.

“It is a process that used to take days, and now, in about 7½ hours, we can talk to clinicians about which antibiotic would be most effective for their patient, and tailor their antibiotic therapy,” Prouse said. “The sooner we get the patient on the right antibiotic, the shorter their illness.”

It has made a difference in the lab, as well, Rosenbaum said. The Accelerate Pheno cuts down on benchwork, and cuts down on susceptibility setups and interpretation and reading the next day, which results in savings. "It is also reducing the time we spend setting up with traditional methods—about 30 mins per specimen. That’s 30 mins that can be used to do something else," he said.

The product has the ability to serve a population in need of quicker response and treatment times. The Centers for Disease Control and Prevention has released data noting that at least 23,000 people die each year from antibiotic-resistant infections.

“This feature is new and unique,” Rosenbaum noted. “It means getting patients on the most appropriate antibiotic days faster, off more-expensive broad-spectrum antibiotics and on the road to recovery.”

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The Accelerate PhenoTM system allows for pathogen identification in only 90 minutes, and is revolutionizing infectious disease diagnostics.

Accelerate Pheno System Speeds Up Antibiotic Susceptibility Diagnostics

This article was sponsored by AstraZeneca

The cardiovascular healthcare environment today is significantly different than it was 20 years ago; new drugs are available for cardiovascular conditions, and the internet has brought a wealth of healthcare education to patients’ fingertips.

Despite these advances, cardiovascular disease (CVD) remains the number 1 cause of death in the world. When we look specifically at acute coronary syndrome (ACS), an umbrella term encompassing aspects of CVD, such as myocardial infarction (MI) and unstable angina, we see that 790000 people have a heart attack in the US each year (580000 new attacks and 210000 recurrent attacks), leading to 114000 deaths.

For patients who have suffered a heart attack, various lifestyle changes can help them manage the risk of another thrombotic cardiovascular (CV) event, including engaging in regular physical activity, managing stress, and following a healthy diet. In addition, guideline driven secondary prevention strategies have been shown to reduce the risk another thrombotic CV event.

 Dual antiplatelet therapy (DAPT), which consists of aspirin plus a second oral antiplatelet (OAP), usually a P2Y

 inhibitor, may play a major role in the treatment paradigm in patients with ACS and has been shown to significantly reduce the risk of subsequent thrombotic cardiovascular events.

However, treatment adherence to post-MI guideline recommendations is poor in patients with ACS. A study by Faridi and colleagues showed that rates of adherence to secondary prevention therapies were no higher than 69% after 3 months and 64% after 1 year.

A study, which analyzed 15 studies from 7 countries, determined the primary variables correlated with nonadherence to P2Y

 inhibitors. These variables included factors related to demographic (eg, age, ethnicity, education), treatment (eg, experiencing side effects), healthcare system process (eg, a lack of discharge information), clinical (eg, pre-existing comorbidities), opportunity (eg, cost), and psychosocial (eg, patient related factors like forgetfulness or feeling treatment is not necessary).

Given the high rates of nonadherence that occur very early after discharge from the hospital, several approaches have been suggested to help improve the chances that patients with ACS will continue taking their medications as prescribed by their doctor. For one, clinicians can educate their patients about developing habits and routines for taking their medications as soon as they are discharged from the hospital, helping to establish a longer-term pattern of adherence.

 As part of this “early intervention” approach, clinicians should consider assessing a patient’s medication use at their first post-MI outpatient visit to encourage continued adherence. If a follow-up cannot be scheduled this early after discharge, clinicians may want to consider other approaches, such as telehealth technologies.

Another approach for helping patients reduce nonadherence is a 90-day medication supply. One study has shown that 90-day prescriptions can increase adherence over 30-day prescriptions.

 This study, conducted by Taitel and colleagues, was a retrospective observational study of California Medicaid claims for over 50,000 patients receiving medication for common chronic illness. Overall, the 90-day medication supply increased adherence by 23% over the 30-day supply, with only nominal drug wastage. Even after subtracting drug wastage compared with the 30-day supply, the 90-day drug supply produced an average drug savings per person per year in the range of $7.00-$26.00 due to the benefit of reduced fees and volume discounts.

Given the potential adherence advantages of a 90-day medication supply, AstraZeneca has introduced the BRILINTA $18 Card that allows eligible commercially insured patients to pay as little as $18 for up to a 90-day supply on each refill, as long as their doctor prescribes BRILINTA. BRILINTA

 (ticagrelor) tablets, which has no generic equivalent, has 98% unrestricted access across commercial insurances. It’s also important to note that for Medicare Part D patients, BRILINTA will cost less than $1.50 per day based on an average co-pay of less than $45 per month. It is crucial to make this empowered patient demographic aware of all potential treatment options and not let cost keep physicians from prescribing the right medication for the right patient.

 is indicated to reduce the rate of cardiovascular death, myocardial infarction (MI), and stroke in patients with acute coronary syndrome (ACS) or a history of myocardial infarction. For at least the first 12 months following ACS, it is superior to clopidogrel. BRILINTA also reduces the rate of stent thrombosis in patients who have been stented for treatment of ACS.

 Additionally, according to the 2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy (DAPT), BRILINTA is preferred over clopidogrel in ACS (Class IIa: LOE B-R).

 BRILINTA is also recommended for use as DAPT for at least 12 months in patients with ACS and as a treatment option in patients with ACS who undergo stent implantation or are managed with medical therapy alone (Class I: LOE B-R).

IMPORTANT SAFETY INFORMATION FOR BRILINTA

WARNING: (A) BLEEDING RISK, (B) ASPIRIN DOSE AND BRILINTA EFFECTIVENESS

BRILINTA, like other antiplatelet agents, can cause significant, sometimes fatal bleeding

Do not use BRILINTA in patients with active pathological bleeding or a history of intracranial hemorrhage

Do not start BRILINTA in patients undergoing urgent coronary artery bypass graft surgery 

If possible, manage bleeding without discontinuing BRILINTA. Stopping BRILINTA increases the risk of subsequent cardiovascular events

B. ASPIRIN DOSE AND BRILINTA EFFECTIVENESS

Maintenance doses of aspirin above 100 mg reduce the effectiveness of BRILINTA and should be avoided

BRILINTA is contraindicated in patients with a history of intracranial hemorrhage or active pathological bleeding such as peptic ulcer or intracranial hemorrhage. BRILINTA is also contraindicated in patients with hypersensitivity (eg, angioedema) to ticagrelor or any component of the product

Dyspnea was reported in about 14% of patients treated with BRILINTA, more frequently than in patients treated with control agents. Dyspnea resulting from BRILINTA is often self-limiting

Discontinuation of BRILINTA will increase the risk of MI, stroke, and death. When possible, interrupt therapy with BRILINTA for 5 days prior to surgery that has a major risk of bleeding. If BRILINTA must be temporarily discontinued, restart as soon as possible

Ticagrelor can cause ventricular pauses. Bradyarrhythmias including AV block have been reported in the post-marketing setting. PLATO and PEGASUS excluded patients at increased risk of bradyarrhythmias not protected by a pacemaker, and they may be at increased risk of developing bradyarrhythmias with ticagrelor

Avoid use of BRILINTA in patients with severe hepatic impairment. Severe hepatic impairment is likely to increase serum concentration of ticagrelor and there are no studies of BRILINTA in these patients

The most common adverse reactions associated with the use of BRILINTA included bleeding and dyspnea: In PLATO, for BRILINTA vs clopidogrel, non-CABG PLATO-defined major bleeding (3.9% vs 3.3%) and dyspnea (14% vs 8%); in PEGASUS, BRILINTA vs aspirin alone, TIMI Total Major bleeding (1.7% vs 0.8%) and dyspnea (14% vs 6%)

Avoid use with strong CYP3A inhibitors and strong CYP3A inducers. BRILINTA is metabolized by CYP3A4/5. Strong inhibitors substantially increase ticagrelor exposure and so increase the risk of adverse events. Strong inducers substantially reduce ticagrelor exposure and so decrease the efficacy of ticagrelor

Patients receiving more than 40 mg per day of simvastatin or lovastatin may be at increased risk of statin-related adverse events

Monitor digoxin levels with initiation of, or change in, BRILINTA therapy

BRILINTA (ticagrelor) tablets is indicated to reduce the rate of cardiovascular death, myocardial infarction (MI), and stroke in patients with acute coronary syndrome (ACS) or a history of myocardial infarction. For at least the first 12 months following ACS, it is superior to clopidogrel.

BRILINTA also reduces the rate of stent thrombosis in patients who have been stented for treatment of ACS.

In the management of ACS, initiate BRILINTA treatment with a 180-mg loading dose. Administer 90 mg twice daily during the first year after an ACS event. After one year administer 60 mg twice daily. Use BRILINTA with a daily maintenance dose of aspirin of 75-100 mg.

Benjamin EJ, Blaha MJ, Chiuve SE, et al. Heart Disease and Stroke Statistics-2017 Update: A Report from the American Heart Association. 

Faridi KF, Peterson ED, McCoy LA, et al. Timing of first postdischarge follow-up and medication adherence after acute myocardial infarction. 

Wiviott SD, Braunwald E, McCabe CH, et al. Prasugrel versus clopidogrel in patients with acute coronary syndromes.

Wallentin L, Becker RC, Budaj A, et al. Ticagrelor versus clopidogrel in patients with acute coronary syndromes.

Yusuf S, Zhao F, Mehta SR, et al. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. 

Bansilal S, Castellano JM, Garrido E, et al. Assessing the impact of medication adherence on long-term cardiovascular outcomes.

Johnston N, Weinman J, Ashworth L, et al. Systematic reviews: causes of non-adherence to P2Y

 inhibitors in acute coronary syndromes in response to intervention. 

Molloy GJ, Messerli-Bürgy N, Hutton G, et al. Intentional and unintentional non-adherence to medications following an acute coronary syndrome: A longitudinal study. 

Ho PM, Spertus JA, Masoudi FA, et al. Impact of medication therapy discontinuation on mortality after myocardial infarction. 

Taitel M, Fensterheim L, Kirkham H, et al. Medication days' supply, adherence, wastage, and cost among chronic patients in Medicaid. 

Brilinta [package insert]. Wilmington, DE: AstraZeneca; 2017.

Levine GN, Bates ER, Bittl JA, et al. 2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients with Coronary Artery Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. 

One study has shown that 90-day prescriptions can increase adherence over 30-day prescriptions.

Sponsored