New Retrospective Studies of Hospital Readmission Rates for Subsequent Heart Attack and Initial Hospitalization Costs in ACS-PCI

 New Retrospective Studies of Hospital Readmission Rates for Subsequent Heart
  Attack and Initial Hospitalization Costs in ACS-PCI Patients Treated with
        Effient® (Prasugrel) or Plavix® (Clopidogrel) Presented at TCT

PR Newswire

MIAMI, Oct. 23, 2012

MIAMI, Oct. 23, 2012 /PRNewswire/ --Daiichi Sankyo, Inc. and Eli Lilly and
Company (NYSE: LLY) today announced new results of two retrospective,
observational, comparative effectiveness studies of U.S. hospital data
comparing rates of readmission for subsequent heart attack and initial
hospitalization costs among patients with acute coronary syndromes (ACS)
treated with a percutaneous coronary intervention (PCI) and antiplatelet
therapy, including Effient^® (prasugrel) or Plavix^®(clopidogrel). The
findings were presented at the 24^th annual Transcatheter Cardiovascular
Therapeutics (TCT) scientific symposium. Sponsored by the Cardiovascular
Research Foundation (CRF), TCT is the world's premier educational meeting
specializing in interventional cardiovascular medicine.

The first study evaluated the rate of rehospitalization for acute myocardial
infarction (AMI) and bleeding at both 30- and 90-days after discharge for
ACS-PCI patients treated with Effient compared to Plavix.[1] Based on a cohort
of 83,567 ACS-PCI patients in the PREMIER database, Effient-treated patients
(n=9,404) had a significantly lower adjusted rate of rehospitalization for AMI
than Plavix-treated patients (n=74,163) at 30 days (Odds Ratio [OR]: 0.89;
p=0.047) and 90 days (OR: 0.90; p= 0.037) following ACS-PCI discharge. The
adjusted rates of bleeding-related rehospitalization were not different
between Effient- and Plavix-treated patients at 30 days (OR: 1.04; p=0.82) or
90 days (OR: 0.92; p=0.51) post-discharge. In the pivotal randomized control
trial, TRITON-TIMI 38, the risk of serious bleeding was significantly higher
with Effient versus Plavix (2.2 percent versus 1.7 percent, respectively).[2]

The second study evaluated use of healthcare resources by Effient-treated
ACS-PCI patients compared to Plavix-treated patients during index
hospitalization (hospitalization that qualified the patients for entry into
the study), as measured by hospital costs.[3] Based on a cohort of 84,695
ACS-PCI patients in the PREMIER database, adjusted estimates of average
hospitalization costs for patients receiving Plavix (n=75,224) or Effient
(n=9,471) were $17,519 (+ or - $2,548) and $17,139 (+ or - $2,560)
respectively – a cost savings of $380 (p<0.05) for Effient-treated patients
during the index hospital stay. Results were consistent across subgroups by
subtype of ACS (STEMI, NSTEMI, and unstable angina). 

"In the current healthcare environment, it is important to understand the
comparative effectiveness of antiplatelet therapies on rehospitalization rates
for subsequent events, such as heart attacks, and index hospitalization costs
associated with their use in the real-world setting," said lead study
investigator Jay P. Bae, Ph.D., health economist, Health Outcomes Research,
Global Health Outcomes, Eli Lilly and Company. "The findings of these studies
expand on data from clinical studies and previous health outcomes research."

The studies were conducted using the PREMIER Perspective Database, a large
U.S. database of drug utilization and other aggregate hospital data on more
than 45 million inpatient discharges and 210 million hospital outpatient
visits from U.S. acute care facilities, ambulatory surgery centers and
clinics.[4] The PREMIER Perspective Database has been selected by the Centers
for Medicare & Medicaid Services for measurement of hospital quality and is
commonly used for outcomes research including studies published in top medical
journals. The data presented at TCT evaluated non-randomized ACS-PCI patients
hospitalized between July 2009 and June 2011. The study endpoints were
pre-specified and the analyses were blinded and conducted by the PREMIER
research team. The studies included ACS-PCI patients treated with Effient who
were on label or Plavix-treated patients who would have been eligible for
Effient treatment per the U.S. prescribing information (i.e., patients who fit
the description of the indication in the U.S. FDA-approved Effient label).[1]

"The results from the PREMIER studies provide physicians with real-world
insights into the use and effectiveness of Effient in ACS-PCI patients in the
United States," said Xin Ye, Ph.D., Director, Health Economics & Outcomes
Research, Daiichi Sankyo, Inc.

This study was adjusted for potential selection bias, including the following
variables: patient age, sex, race, type of ACS diagnosis, comorbidities and
details of intervention.

The studies were conducted by researchers at Lilly and the Premier Healthcare

Assessment of Observed Rates of 30- and 90-Day Rehospitalization for AMI and
Bleeding in Patients with ACS-PCI: Comparison of Effient and Plavix

The observed rates of 30- and 90-day rehospitalization due to AMI and 30- and
90-day bleeding-related rehospitalization rates among ACS-PCI patients treated
with Effient or Plavix in a real-world U.S. hospital setting were also
presented at TCT. At 30-days, the unadjusted AMI-related rehospitalization
rates were significantly lower for Effient as compared to Plavix (3.9 percent
and 4.7 percent, respectively; p<0.05). At 90-days, the unadjusted
AMI-related rehospitalization rates were significantly lower for Effient as
compared to Plavix (5.1 percent and 6.3 percent, respectively; p<0.05).

The unadjusted bleeding-related rehospitalization rate was 0.5 percent in
Effient-treated patients compared to 0.8 percent in Plavix-treated patients at
30-days (p<0.05) and 0.8 percent in Effient-treated patients compared to 1.4
percent in Plavix-treated patients at 90-days (p<0.05) post-discharge.

Observed Mean Length of Stay, Hospitalization Costs and Bleeding Rates of
ACS-PCI: Comparison of Effient and Plavix

The goal of this analysis was to compare observed mean length of stay, total
costs and bleeding rates associated with the index hospitalization –
hospitalization that qualified the patients for entry into the study – for
ACS-PCI patients treated with Effient or Plavix. Across the entire study
population, the unadjusted mean length of stay was 2.9 + or - 2.4 days for
Effient-treated patients as compared to 3.5 + or - 4.4 days for Plavix-treated
patients (p<0.05). The actual observed mean hospitalization costs for
Effient-treated patients were $16,199 + or - $10,054 compared to $17,647 + or
- $16,696 for Plavix-treated patients (p<0.05).

In the study, unadjusted rates of bleeding (defined as the presence of
bleeding ICD-9 codes) were 2.2 percent and 3.3 percent in Effient- and
Plavix-treated patients, respectively (p<0.05).

Unadjusted rates of transfusion were 1.2 percent and 3.1 percent in Effient-
and Plavix-treated patients, respectively (p<0.05). Unadjusted rates of
bleeding or transfusion were 3.2 percent and 5.7 percent in Effient- and
Plavix-treated patients, respectively (p<0.05).

In the pivotal randomized control trial, TRITON-TIMI 38, the risk of serious
bleeding was significantly higher with Effient versus Plavix (2.2 percent
versus 1.7 percent, respectively).[2]

Limitations of the PREMIER Database Studies

Although significant demographic, clinical, treatment- and
intervention-related data were used to adjust for potential bias in these
studies, other unrecognized sources of bias may still exist in any
non-randomized database study. For example, the PREMIER database did not
include data on patient characteristics, such as blood pressure, height and
weight. The lack of weight data is important, since weight is a predictor of
risk for bleeding. The researchers plan to conduct additional quantitative
analysis on potential sources of bias in the database.

About Acute Coronary Syndrome

ACS, which includes heart attack and a type of chest pain called unstable
angina (UA), affects more than one million people in the United States
annually.[5] The annual incidence of new heart attacks is estimated to be
approximately 610,000 and about 325,000 people will have a recurrent attack. ^
There are two main types of heart attack: non-ST-segment elevation, or NSTEMI,
and ST-segment elevation, or STEMI. STEMI heart attacks are often considered
more severe as the artery is often fully blocked, preventing blood flow to the

Each year, approximately 596,000 people undergo PCI, which typically includes
the implantation of a stent that restores blood flow to blocked arteries in
the heart. The number of UA or NSTEMI ACS patients worldwide who are managed
without acute coronary interventions, such as PCI, has ranged from 32 percent
to almost 60 percent over the last few years.[6],[7] In many cases, these ACS
patients may have complex coronary anatomy, comorbidities or other high-risk
factors that prevent surgical intervention.^

ACS may result in heart attack, stroke and death, costing Americans more than
$150 billion each year.[8] Nearly 60 percent of the U.S healthcare costs of
ACS are due to re-hospitalization. Strategies to prevent recurrent heart
attacks and re-hospitalization are important to improve patient outcomes and
reduce the cost burden of ACS.

About Effient

Daiichi Sankyo Company, Limited (TSE: 4568), and Eli Lilly and Company (NYSE:
LLY) co-developed Effient, an oral antiplatelet agent discovered by Daiichi
Sankyo and its Japanese research partner, Ube Industries, Ltd. Effient helps
keep blood platelets from clumping together and developing a blockage in an
artery. Effient ^ is indicated to reduce the rate of thrombotic CV events
(including stent thrombosis) in patients with ACS who are to be managed with
an artery-opening procedure called PCI as follows: [1] patients with UA or
NSTEMI; [2] patients with ST-elevation myocardial infarction (STEMI) when
managed with primary or delayed PCI. The loading dose of Effient is 60 mg and
the maintenance dose is 10 mg once daily. Effient is available in 5-mg and
10-mg tablets.

Important Safety Information

What is the most important information patients should know about Effient?

Effient^® (prasugrel) can cause bleeding. If patients have unexplained or
excessive bleeding while on Effient, they should contact their doctor right
away as some bleeding can be serious, and sometimes fatal. Patients should not
take Effient if they currently have abnormal bleeding, such as stomach or
intestinal bleeding, bleeding in their head, or have a history of stroke, or
"mini-stroke" (also known as transient ischemic attack or TIA), or are
allergic to prasugrel or any of the ingredients in Effient.

Patients should get medical help right away if they suddenly have slurring of
speech, weakness or numbness in one part of their body, blurry vision, and/or
severe headache. These may be symptoms of a stroke or TIA. If patients have a
stroke or TIA while taking Effient, their doctor will probably stop Effient.
Before having any surgery, patients should talk to their doctor about stopping
Effient. If possible, patients should stop taking Effient at least 1 week (7
days) before any surgery, as instructed by their doctor who prescribed
Patients may also have a higher risk of bleeding if they take Effient and
they: a) are age 75 or older, b) weigh less than 132 pounds, c) are taking
anticoagulants (eg, warfarin) or regular daily use of NSAIDs, d) have had
recent trauma, such as an accident or surgery, e) have severe liver problems,
or f) have a stomach ulcer.
Patients should not stop taking Effient without talking to the doctor who
prescribes it for them. People who are treated with angioplasty and have a
stent, and stop taking Effient too soon, have a higher risk of a blood clot in
the stent, having a heart attack, or dying.

What should patients tell their doctor before taking Effient?

Patients should tell their doctor about all of their medical conditions,
allergies, and medicines they are taking.

What are the possible side effects of Effient?

Bleeding is the most common side effect of Effient.

TTP, a rare but life-threatening condition, has been reported with Effient,
sometimes after a short time (less than 2 weeks). Patients should get medical
attention right away if they develop the following unexpected symptoms of TTP:
fever, weakness, yellowing of the skin or eyes, or if skin becomes very pale
or dotted with purple spots.

Serious allergic reactions can happen with Effient, or if the patient has had
a serious allergic reaction to the medicines Plavix^® (clopidogrel) or
ticlopidine. Patients should get medical help right away if they get any of
these symptoms of a severe allergic reaction: swelling or hives of their face,
lips, in or around their mouth, or throat, trouble breathing or swallowing,
chest pain or pressure, dizziness or fainting.

Other side effects may occur.

For more information about Effient, please see the Prescribing Information at, including Boxed Warning regarding bleeding
risk, and Medication Guide at You may
also learn more about Effient at

About Daiichi Sankyo

The Daiichi Sankyo Group is dedicated to the creation and supply of innovative
pharmaceutical products to address the diversified, unmet medical needs of
patients in both mature and emerging markets. While maintaining its portfolio
of marketed pharmaceuticals for hypertension, hyperlipidemia, and bacterial
infections, the Group is engaged in the development of treatments for
thrombotic disorders and focused on the discovery of novel oncology and
cardiovascular-metabolic therapies. Furthermore, the Daiichi Sankyo Group has
created a "Hybrid Business Model," which will respond to market and customer
diversity and optimize growth opportunities across the value chain. For more
information, please visit Daiichi Sankyo, Inc.,
headquartered in Parsippany, New Jersey, is a member of the Daiichi Sankyo
Group. For more information on Daiichi Sankyo, Inc., please visit

About Eli Lilly and Company
Lilly, a leading innovation-driven corporation, is developing a growing
portfolio of pharmaceutical products by applying the latest research from its
own worldwide laboratories and from collaborations with eminent scientific
organizations. Headquartered in Indianapolis, Ind., Lilly provides answers –
through medicines and information – for some of the world's most urgent
medical needs. Additional information about Lilly is available at

This press release contains certain forward-looking statements about Effient
for the reduction of thrombotic cardiovascular events (including stent
thrombosis) in patients with acute coronary syndromes who are managed with
percutaneous coronary intervention and reflects Daiichi Sankyo's and Lilly's
current beliefs. However, as with any pharmaceutical product, there are
substantial risks and uncertainties in the process of development and
commercialization. There is no guarantee that future study results and
patient experience will be consistent with study findings to date or that the
product will be commercially successful. For further discussion of these and
other risks and uncertainties, see Lilly's filing with the United States
Securities and Exchange Commission and Daiichi Sankyo's filings with the Tokyo
Stock Exchange. Daiichi Sankyo and Lilly undertake no duty to update
forward-looking statements.

Effient^® is a registered trademark of Eli Lilly and Company.

Plavix^® is a registered trademark of Sanofi-Aventis Corp.


[1] Bae JP, Faries DE, Ernest FR et al. Assessment of 30-Day Rehospitalization
for Acute Myocardial Infarction in Patients with Acute Coronary Syndrome Who
Received Percutaneous Coronary Intervention: A Comparative Effectiveness Study
of Clopidogrel and Prasugrel. Abstract TCT-53. 2012 Transcatheter
Cardiovascular Therapeutics Annual Meeting, Miami, FL.
[2] Effient Prescribing Information (U.S.).
[3] Bae JP, Ernst FR, Lipkin C, et al. Hospitalization Costs of Acute Coronary
Syndrome Patients Undergoing Percutaneous Coronary Intervention: A Comparison
Between Clopidogrel and Prasugrel Patients in a US Hospital Database. Abstract
730. 2012 Transcatheter Cardiovascular Therapeutics Annual Meeting, Miami, FL.
[4] Premier Research Services^®.
[5] Roger VL, Go AS, Lloyd-Jones DM, et al. for the American Heart Association
Statistics Committee and Stroke Statistics Subcommittee. Heart disease and
stroke statistics – 2012 update. Circulation.
[6] Fox KAA, Steg PG, Eagle KA, et al. Decline in rates of death and heart
failure in acute coronary syndromes, 1999-2006. J Am Med Assoc.
[7] Chan MY, Mahaffey KW, Sun LJ, et al. Prevalence, predictors, and impact of
conservative medical management for patients with non-ST-segment elevation
acute coronary syndromes who have angiographically documented significant
coronary disease. J Am Coll Cardiol. 2008;1:369-378.
[8] Kolansky DM. Acute coronary syndromes: Morbidity, mortality and
pharmacoeconomic burden. Am J Manag Care. 2009;15:S36-S41.

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SOURCE Eli Lilly and Company

Contact: Christina D. Gaines, APR, Eli Lilly and Company, +1-317-276-3845
(office), +1-317-366-2568 (cell); or Alyssa Dargento, Daiichi Sankyo (U.S.A.),
+ 1-973-944-2913 (office), +1-973-727-1604 (cell); or Michaela Paudler-Debus,
PhD, Daiichi Sankyo (Tokyo), +81-3-6225-1338 (office), +81 80 4359 9421 (cell)
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