Seeking a Population That Derives a Significant Benefit from Prasugrel

Prasugrel sales are flagging, despite the robust marketing efforts that followed TRITON-TIMI 38 (JW Cardiol Nov 4 2007). Five years later, we have another industry-sponsored prasugrel trial, now in patients with acute coronary syndromes (ACS) without ST-segment elevation who are not treated with revascularization. In this trial, TRILOGY ACS, investigators randomized 7243 such patients younger than 75 to receive prasugrel (10 mg daily) or clopidogrel (75 mg daily) for up to 30 months.

All patients had one of four risk factors — age ≥60 years, diabetes, prior myocardial infarction (MI), or prior revascularization — and all received aspirin. The primary endpoint was a composite of cardiovascular death, nonfatal MI, and nonfatal stroke. The stud…