On Tuesday 12th Nov, at the American Heart Association’s scientific meeting in Dallas, Daiichi Sankyo announced the results of ‘engage AF’, their large late stage trial of Xa inhibitor edoxaban.
The trial followed over 21,100 patients with atrial fibrillation, at moderate to high risk of a stroke, for nearly three years. For decades sufferers of atrial fibrillation, a dangerously irregular heartbeat, have taken warfarin, a drug that requires constant supervision of patients blood levels, regular adjustments to dosage and diet, and carries a high risk of bleeding out.
Reuters reports that the results of the large scale trial was the demonstration of edoxaban’s ‘non-inferiority’ to warfarin. Though a bit more detail reveals just how close edoxaban came to being ‘superior’:
- 60mg dose reduced blood clots and strokes by 21% compared to warfarin.
- 30mg dose had a high rate of ischemic strokes caused by blocked blood vessels.
- Severe hemorrhagic strokes: (which often result in fatality) by 46% compared to warfarin.
- Severe hemorrhagic strokes: 67% reduction compared to warfarin.
- Major Bleeding: reduced by 20% for the 60mg dose.
- Major Bleeding: reduced by 53% for the 30mg dose.
These are clearly promising results, especially as they have come from such a large trial. But what does the future hold in store of edoxaban?
Unfortunately for Daiichi Sankyo this is by no means a one horse race. With drugs from Bayer and Johnson & Johnson (Xarelto), Bristol-Myers Squibb and Pfizer (Eliquis), all trying to usurp warfarin, but a lack of trials making a direct comparison between these new drugs means the sector is likely to become a marketing warzone.
One thing that may divide the market place is that edoxoban along with Bayer and Johnson & Johnson’s Xarelto are each once a day treatments.
But will any of the available treatments offer the same value for money that the vastly cheaper warfarin can?
Well despite the higher costs, there are clearly huge safety advantages to be found in the new line of blood thinners, as well as reduced costs for providers who will no longer need to track and monitor patients so closely. And with competition set to be fierce, we may well see a drop in price for this new generation of blood thinners.
If you’re keen to see how the market reacts to the entrance of these new Xa inhibitors, you may well be interested in attending Pharma Pricing & Market Access Outlook Europe.