Oral dabigatran etexilate reduces the risk of stroke and systemic embolism

Aug 31 2009

Boehringer Ingelheim today announced data from the landmark RE-LY^® study - the largest atrial fibrillation (AF) outcomes trial ever conducted (18,113 patients in 44 countries worldwide) - presented for the first time at the European Society of Cardiology Congress and published online in the New England Journal of Medicine. Results show that dabigatran etexilate 150mg BID significantly reduces the risk of stroke and systemic embolism by 34% (p<0.001) in patients with atrial fibrillation compared to well-controlled warfarin without increasing the risk of major bleeding. Dabigatran etexilate 110mg BID clearly demonstrated similar reductions in stroke and systemic embolism compared to well controlled warfarin while delivering an impressive 20% reduction>

Similarly impressive are the results in key secondary and other outcomes, including superior reduction in hemorrhagic strokes with both 150mg and 110mg BID doses (RRR 74%, p<0.001 and RRR 69%, p<0.001, respectively), and a reduction in vascular mortality with the 150mg BID dose (RRR 15%,>

“The results of dabigatran in RE-LY^® exceeded all our expectations. We now have an oral treatment which offers superior protection from stroke with less bleeding and without the need for routine monitoring. In addition to protecting patients from strokes, we as physicians are especially concerned about life-threatening or disabling bleeding with warfarin due to its narrow therapeutic window. On top of the efficacy, dabigatran has shown equally impressive safety results, offering a wider safety margin,” commented Professor Stuart Connolly, co-principal investigator of RE-LY^® and Director, Division of Cardiology at The Population Health Research Institute, McMaster University, Hamilton, Canada.

Up to 3 million people worldwide suffer strokes related to AF each year, which tend to be especially severe and disabling, with half of people dying within one year. Taking into consideration only the potential of stroke reduction - and translating the RE-LY^® results into clinical practice - dabigatran etexilate 150mg BID could prevent approximately 3,000 strokes per day worldwide compared to well controlled warfarin. The clinical and economic impact could be even greater when the reduction of severe or disabling bleeding is considered.

“For decades, an advance in this area has been eagerly awaited by patients and treating physicians alike,” said Dr Sarah Jarvis, general practitioner in the UK. “Doctors and patients are looking forward to a new therapy that can effectively and predictably reduce their risk of stroke without imposing restrictions on their lives. The need for lifelong blood tests and dose adjustments and the numerous food and drug interactions with warfarin have had a significant adverse impact on patients’ quality of life while placing many of them at continued risk of stroke and major bleeding. This could soon be a thing of the past.”

Warfarin and other vitamin-K antagonists are highly effective when patients blood clotting value is maintained within the narrow therapeutic INR range of 2.0-3.0 as in a clinical trial setting. However in clinical practice - due to the well-known limitations with warfarin - only 51% of diagnosed patients with AF and at risk of stroke receive warfarin⁷ and fewer than half of these are controlled within the narrow therapeutic range.

Potent antithrombotic effects are achieved with direct thrombin inhibitors by specifically blocking the activity of thrombin (both free and clot-bound), the central enzyme in the process responsible for clot (thrombus) formation. In contrast to vitamin-K antagonists, which variably act via different coagulation factors, dabigatran etexilate provides effective, predictable and consistent anticoagulation with a low potential for drug-drug interactions and no drug-food interactions, without the need for routine coagulation monitoring or dose adjustment.

“With the robust results from RE-LY^® dabigatran etexilate, a compound from our own research and development, can revolutionize anticoagulant treatment for physicians and patients,” commented Dr Andreas Barner, the chairman of the Board of Managing Directors of Boehringer Ingelheim. “We look forward to expeditiously submitting these results to regulatory authorities around the world so that new options can be made available for millions of patients with atrial fibrillation at risk of stroke.”