The US Food and Drug Administration (FDA) has approved Boehringer Ingelheim Pharmaceuticals' Pradaxa (dabigatran etexilate mesylate) for the treatment of deep venous thrombosis (DVT) and pulmonary embolism (PE) in patients who have been treated with a parenteral anticoagulant for five to 10 days, and to reduce the risk of recurrent DVT and PE in patients who have been previously treated. DVT and PE are collectively referred to as venous thromboembolism (VTE). There are an estimated 900,000 DVT and PE events per year in the US , approximately one-third of which result in death from PE.
“Venous thromboembolism is the third most common cardiovascular disease after myocardial infarction and stroke. About one-third of patients with a DVT or PE will suffer a recurrence within 10 years,” said Samuel Z. Goldhaber, managing director, director of Brigham and Women’s Hospital’s Thrombosis Research Group and Professor of Medicine, Harvard Medical School. “Dabigatran has established efficacy and safety for stroke risk reduction in patients with non-valvular atrial fibrillation. This new FDA approval expands dabigatran’s indications to include treatment and the reduction of the risk of recurrence of DVT and PE.”
The approval is based on results from four global Phase III studies evaluating the efficacy and safety of PRADAXA in the treatment of DVT and PE.
The RE-COVER and RE-COVER II trials, which included patients with DVT and PE who were treated with parenteral anticoagulant therapy for five to 10 days, showed PRADAXA was non-inferior to warfarin in reducing DVT and PE after a median of 174 days of treatment, and was associated with lower rates of overall bleeding and a higher rate of any gastrointestinal (GI) bleeding (3.1 per cent vs. 2.4 per cent). RE-MEDYSM, which included patients who had been previously treated for an acute DVT and PE with anticoagulant therapy for three to 12 months, showed PRADAXA was non-inferior to warfarin in reducing DVT and PE after a median of 534 days of treatment, and was associated with lower rates of overall bleeding and a higher rate of any GI bleeding (3.1 per cent vs. 2.2 per cent).
RE-SONATE, which included patients who had been previously treated for an acute DVT and PE with anticoagulant therapy for six to 18 months, showed PRADAXA reduced the risk of DVT and PE recurrence by 92 percent compared to placebo after a median of 182 days of treatment: 0.4 percent vs. 5.6 per cent; HR = 0.08 [CI 0.02, 0.25]. PRADAXA was associated with higher rates of any bleeding (10.5 percent vs. 6.1 per cent; HR = 1.77 [CI 1.20, 2.61]), clinically relevant non-major bleeding (5.0 percent vs. 2.0 per cent; HR = 2.54 , and GI bleeding (0.7 percent vs. 0.3 percent) compared to placebo.
A DVT occurs when a blood clot blocks the normal flow of blood through a vein, usually in the leg or pelvis, which may lead to swelling or pain in the affected leg. A PE occurs when a DVT, or part of it, breaks off and travels through the bloodstream to the lungs, blocking a vessel. The symptoms of a PE include shortness of breath and chest pain. It may also cause other symptoms like cough, rapid heart rate and dizziness. A PE can be life-threatening and requires urgent treatment. The standard of care for patients with a DVT or PE has been acute treatment with parenteral anticoagulation therapy, such as low-molecular-weight heparin [LMWH], followed by long-term treatment with an oral vitamin K antagonist (e.g., warfarin).
“Deep vein thrombosis and pulmonary embolism can be life-threatening. Boehringer Ingelheim is pleased that patients will now have a new and efficacious therapeutic option for this complex condition,” said Sabine Luik, managing director, senior vice president, Medicine & Regulatory Affairs, Boehringer Ingelheim Pharmaceuticals, Inc. “This approval is a testament to our commitment to evaluate PRADAXA in new areas of cardiovascular treatment, in order to address evolving patient needs.”