Ticagrelor No Better Than Clopidogrel in Patients with Symptomatic Peripheral Artery Disease

Ticagrelor is a more expensive platelet inhibitor than clopidogrel, prompting ticagrelor's manufacturer to sponsor comparative-effectiveness studies. In the EUCLID trial, 13,885 people (median age, 66; 72% men) with symptomatic peripheral artery disease (PAD) were randomized, in double-blind fashion, to receive ticagrelor (90 mg twice daily) or clopidogrel (75 mg once daily). About three quarters of the participants were taking statins.

During a median follow-up of 30 months, incidence of the primary endpoint — cardiovascular death, myocardial infarction, or ischemic stroke — was statistically similar with ticagrelor and clopidogrel, both overall (10.8% and 10.6%, respectively) and in most prespecified subgroups. Secondary outcomes were also similar with the two drugs, as was the incidence of major bleeding. Discontinuation related to adverse effects was significantly more common with ticagrelor than clopidogrel.