AstraZeneca Heart Drug Proves Worthy, Elevating Sales Potential

AstraZeneca Plc’s Brilinta reduces the risk of death from heart attack or stroke long after an initial attack, according to research that may bring billions of dollars to the company as more people use the drug for extended periods.

The anti-clotting medicine also was shown to work without causing an unacceptable level of bleeding, a key issue for blood thinners, the study team announced today at the American College of Cardiology’s annual meeting in San Diego.

Patients now receive drugs such as Brilinta, combined with aspirin, for about a year after a heart attack, then switch to aspirin alone. In the latest trial, patients who took Brilinta, also known as ticagrelor, and aspirin for an average of 33 months after their heart attack had a reduction in serious cardiovascular events of about 15 percent, without excess side effects.

“In my practice, I would start a patient when they came in with a heart attack and I would keep them on ticagrelor long-term as long as they are tolerating it,” Marc Sabatine, the lead investigator on the study, said in an interview. “These data support the notion you should continue ticagrelor indefinitely.”

The results bolster AstraZeneca’s claims for the drug, which it predicts will bring in annual sales of $3.5 billion by 2023, based on expanded use for heart attack patients as well as moving into additional disease areas such as stroke and diabetes. Brilinta, which is sold as Brilique in Europe, had sales of $476 million in 2014.

Unlocking Potential

“The study should be a major driver for treatment duration and thus finally unlock Brilinta’s multibillion-dollar potential,” Alexandra Hauber, an analyst at UBS AG, said in a note to investors before the trial results were announced. The expanded patient population created by the recent study could add $2.5 billion in sales, she said.

The risk of bleeding did increase, to about 2.5 percent for patients taking Brilinta compared to 1 percent for those taking a placebo, said Sabatine, a cardiologist at Brigham and Women’s Hospital in Boston.

“As expected with a blood thinner, we observed an increase of bleeding, but there was no excess of fatal bleeding or bleeding into the brain,” he said in a statement announcing the findings.

AstraZeneca, the U.K’s second-biggest drugmaker, reported preliminary results of the study in January.

Generic Competitor

The company has struggled to gain acceptance for Brilinta from cardiologists since the drug was introduced in 2011, in part because of the success of clopidogrel, an anti-platelet sold as Plavix and now available as a generic. Clopidogrel costs about $12 a month, compared to about $270 for Brilinta.

The new study only tested Brilinta for use beyond a year, so doctors don’t have evidence that clopidogrel provides the same benefit. But the rival medicine may get prescribed for the new indication anyway, which would dent Brilinta’s advantage, Tim Anderson, an analyst at Sanford C. Bernstein, said in a note.

A recent analysis showed that in the U.S., generic Plavix is already being prescribed for longer periods in 20 percent of patients similar to those in the Brilinta study, he said.

The Brilinta trial, dubbed Pegasus, involved more than 21,000 patients who had suffered a heart attack. Some were given the drug twice daily in a 90 milligram dose, while others got 60 milligrams twice a day or a placebo. All took low-dose aspirin.

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