WHILE human population continues to grow and the people living longer, the prevalence of non-valvular atrial fibrillation (NVAF) is also increasing.
To reduce the risk of stroke and systemic embolism in patients with NVAF, Pfizer Inc. (Philippines) recently announced the newly approved indication of its latest breakthrough drug—the Eliquis [apixaban], an oral anticoagulant. The product was developed together with Bristol Myers-Squibb. This product is a major development in anticoagulation since the discovery of warfarin more than 50 years ago.
Dr. Cristina San Jose, a neurologist, said that Atrial fibrillation, the most common type of irregular heartbeat, affects approximately 5.2 million Americans in 2010. San Jose is a clinical associate professor in the University of the Philippines College of Medicine and a neurologist in the Philippine General Hospital (PGH). She is also the head of the Diosdado Macapagal Stroke Center, the fellowship training officer of the Stroke Service and the head of Acute Stroke Unit at St. Luke’s Medical Center.
She said that patients with atrial fibrillation have a higher risk of blood clots forming in the atria. The clot can become dislodged, make its way to the bloodstream and end up in the brain, where it can cause a stroke. Strokes can result to brain damage, and serious behavioral and physical problems, and even death.
Atrial fibrillation is also the most common cardiac arrhythmia or irregular heart beat. The lifetime risk of developing this condition is estimated to be approximately 25 percent for individuals 40 years of age or older.
In addition, one of the most serious medical concerns for individuals with atrial fibrillation is the increased risk of stroke, which is five times higher in people with condition than those without it.
Eliquis (apixaban) versus warfarin
San Jose said that apixaban represents a significant advance over warfarin for physicians to reduce the risk of stroke in patients with NVAF.
Warfarin also belongs to a class of medicines called anticoagulants. It is used to prevent blood clots from forming and may also be used to treat bloodclots, which have already formed. Warfarin works by slowing the production of some of the chemicals in your body that are needed for blood clotting.
Eliquis is said to be the only oral anticoagulant to demonstrate superior risk reduction versus warfarin in the three important outcomes of stroke and systemic embolism, major bleeding and all-cause mortality.
It is an oral direct Factor Xa inhibitor, part of a novel therapeutic class.
San Jose added that based on Samsa GP et al. Arch Intern Med 2000:160: 967-973 study: warfarin is the only and old drug (50 years); with proven treatment; highly effective (if and when used correctly); and underutilized clinical practice wherein about 65 percent of eligible patients are not on warfarin. However, Warfarin therapy requires several things and has some issues regarding its application.
Warfarin therapy also need: Regular blood exam (prothrombin time-INR testing) while other challenges to warfarin therapy (physician and patient-related factors) include: doctor’s “fear” of bleeding, doctor’s experience with dose adjustment, and need for lifetime monitoring
On the other hand, apaxiban thus work, she said, for it is “at least as effective (or more effective) than warfarin, associated with less bleeding than warfarin.
It is believed to be the “ideal” anticoagulant, convenience-wise—taken orally, fixed dose, no need for monitoring, with wide therapeutic window and has less drug interaction.
Violi Remo, Pfizer Inc. (Philippinees) country manager, said that at present the anticoagulant has become an even more valuable medicine as it has also been approved to reduce burden of stroke among patients with non-valvular atrial fibrillation.
“This new indication is a testament to our commitment to invest in research with the noble objective of bringing new treatment solutions that our patients can rely on. We believe that this is one of our key contributions to the society in which we can operate,” Remo concluded