Doubts over landmark heart drug trial: ticagrelor PLATO study
A top selling antiplatelet drug has never quite shaken off doubts about its advantage over cheaper rivals. With generic versions of ticagrelor about to launch, Peter Doshi takes a fresh look at the evidence Over the past decade the antiplatelet drug ticagrelor (Brilinta in the US and Brilique in Europe) has become firmly established in the treatment of acute coronary syndrome, recommended in guidelines from cardiology societies across the world.123 As the only P2Y12 inhibitor still under patent in the US, the public expenditure is substantial, accounting for around two thirds of the total cost of P2Y12 inhibitors despite less than 10% of total prescriptions.4 In 2022, the US federal government spent more than $750m (£593m; €712m) on ticagrelor. But since its 2011 approval by the US Food and Drug Administration (FDA) doubts have grown about its apparent advantage over cheaper, off patent P2Y12 inhibitors like clopidogrel and prasugrel. While AstraZeneca, ticagrelor’s manufacturer, repor
