Positive results from a sub-group analysis of the landmark Randomised Evaluation of Long-Term Anticoagulant Therapy (RE-LY®) trial were published this week (9 November) in the Lancet Neurology.
The RE-LY® trial is the largest atrial fibrillation (AF) outcomes trial ever completed, with 18,113 patients in 44 countries worldwide.
The new findings show that AF patients with previous stroke or transient ischemic attack (TIA) may benefit substantially from treatment with dabigatran etexilate.
The new sub-group analysis from RE-LY® included 3,623 AF patients who had suffered a stroke or TIA before enrollment into the trial.
The results of the sub-group analysis were consistent with the overall trial results for the major efficacy and safety outcomes.
This was confirmed by an interaction analysis which showed that results in patients with previous stroke or TIA were consistent with the overall results found in the RE-LY® trial.
The 150 mg dose of dabigatran etexilate provided a substantial 25% reduction in relative risk compared with well controlled warfarin in the combined endpoint of stroke and systemic embolism in the sub-group of patients with previous stroke or TIA in line with the results of the main RE-LY® trial.
However, due to the five fold smaller sample size of this subpopulation compared to RE-LY®, this difference did not reach statistical significance.
Impressively, both doses (110 mg BID and 150 mg BID) also demonstrated significant reductions in intracranial bleeds versus well controlled warfarin.
These findings support the overall striking results of RE-LY® in the prevention of stroke and systemic embolism of dabigatran etexilate within a patient sub-group who are at 2.5 times increased risk compared with a typical AF patient without previous stroke or TIA, who themselves are already at five times increased risk.
Based on the convincing results of RE-LY®, dabigatran etexilate was approved in the USA for stroke risk reduction in patients with non-valvular AF and in Canada for the prevention of stroke and systemic embolism in patients with AF for whom anticoagulation is appropriate.
New data from the RE-LY®trial and dabigatran etexilate will be available at this year’s American Heart Association Scientific Sessions 2010, Chicago, U.S, 13–17 November.