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Categories: AF Atrial fibrillation Drugs Pradaxa RE-LY

Boehringer Ingelheim`s novel oral anticoagulant dabigatran etexilate is the frontrunner for stroke prevention in atrial fibrilla

Ingelheim/Germany, 20 March 2009 - Boehringer Ingelheim today announced that the last patient has completed treatment in the landmark phase III Randomized Evaluation of Long term Anticoagulant therapy (RE-LY®) study. This study compares the long-term efficacy and safety of the novel, oral direct thrombin inhibitor dabigatran etexilate (Pradaxa®) with the current standard therapy, warfarin (target international normalized ratio, INR, 2-3) for the prevention of stroke and systemic embolism in patients with atrial fibrillation (AF). Pradaxa® is the most advanced oral anticoagulant in development in this therapeutic area. RE-LY®, the largest stroke prevention in AF trial to date, enrolled 18,113 patients, in over 900 centres in 44 countries worldwide between December 2005 and December 2007. Data will now be analysed and results are expected to be presented later this year at the European Society of Cardiology (ESC) Congress, taking place in Barcelona, Spain, from August 29th until September 2nd 2009.

“We are proud to announce completion of treatment of the last patient in the RE-LY study, which is addressing a key area of unmet clinical need, and would like to thank patients and investigators involved,” commented Dr Manfred Haehl, Corporate Senior Vice President Medicine, Boehringer Ingelheim, “this marks another milestone in our extensive RE-VOLUTION programme involving over 38,000 patients evaluating our novel oral direct thrombin inhibitor dabigatran etexilate in a range of thromboembolic conditions.”

AF is the most common heart rhythm condition, affecting 1% of the total population and 10% of those over 80 years, with prevalence expected to rise due to the ageing society.1,2 In 2007, 6.3 million people in the US, Japan, Germany, Italy, France, UK and Spain were living with diagnosed AF.3 People with AF are at an increased risk of blood clots,4 raising their risk of stroke by up to seven times.5 Two out of three strokes due to AF can be prevented with appropriate anticoagulant therapy.6 Vitamin K antagonists (warfarin, coumarins) are the current standard therapy7 and are highly effective when patients are maintained within the therapeutic INR range of 2.0-3.0 for the majority (60-70%) of time.8 Due to the limitations associated with vitamin K antagonists, such as numerous drug-drug/drug-food interactions and a slow onset of effect, maintaining patients within this narrow therapeutic range is difficult for clinicians and requires frequent monitoring of the drug’s effects to ensure optimal patient safety.9 A retrospective review demonstrated that patients in routine clinical practice only spend approximately half of the time in the therapeutic INR range.10

Moreover, it is estimated that approximately 50% of patients diagnosed with AF and at risk of stroke, who are eligible for warfarin therapy according to guidelines, do not receive anticoagulant treatment.11 A key reason is the limitations associated with warfarin which make it unsuitable for many patients, however there is no effective alternative therapeutic option for this group.11 Thus, applying guideline therapeutic recommendations to real-world practice is challenging for physicians and patients.11 There is a need for an effective and safe new oral anticoagulant without the limitations of vitamin K antagonists. Pradaxa® provides predictable, consistent anticoagulation with a low potential for drug-drug interactions and no drug-food interactions, without the need for routine coagulation monitoring or dose adjustment.

Notes to editors
About the RE-LY® study
RE-LY® is investigating whether the novel oral direct thrombin inhibitor dabigatran etexilate (2 blinded doses) is as effective as well controlled warfarin (open label) for stroke prevention in patients with non-valvular AF and at least one other major risk factor for stroke (i.e., previous ischaemic stroke, transient ischaemic attack, systemic embolism, left ventricular dysfunction, age =/>75 years, age =/>65 with either diabetes mellitus, history of coronary artery disease, or hypertension). Patients have been followed for a minimum of 1 year.

The primary outcome of the trial is incidence of stroke (including haemorrhagic) and systemic embolism. Secondary outcome measures include all death, incidence of stroke (including haemorrhagic), systemic embolism, pulmonary embolism, acute myocardial infarction and vascular death (including death from bleeding). Additional safety endpoints include major and minor bleeding events, intracerebral haemorrhage, elevations in liver transaminases, bilirubin and hepatic dysfunction.

About Pradaxa® (dabigatran etexilate)
Pradaxa® – a direct reversible thrombin inhibitor – is at the forefront of a new generation of oral anticoagulants targeting a high unmet medical need in the prevention and treatment of acute and chronic thromboembolic diseases. Direct thrombin inhibitors provide an anticoagulant effect by specifically and selectively blocking the activity of thrombin (both free and clot-bound), the central enzyme in the process responsible for clot (thrombus) formation – conversion of fibrinogen to fibrin.

Pradaxa® has already been approved and is widely utilized in over 28 countries for the primary prevention of venous thromboembolic events (blood clots) in adults who have undergone elective total hip or elective total knee replacement surgery.

RE-LY® is part of Boehringer Ingelheim’s extensive RE-VOLUTION® clinical trial program – evaluating the efficacy and safety of dabigatran etexilate against current standard therapy in over 38,000 patients. Beyond RE-LY® the RE-VOLUTION® trial program encompasses studies in:

  • Primary prevention of venous thromboembolism (VTE)
  • Treatment of acute VTE – results expected in 2009 from the RE-COVER™ trial
  • Secondary prevention of VTE in the RE-MEDY™ and RE-SONATE™ trials
  • Prevention of cardiac events in patients with acute coronary syndrome in the RE-DEEM™ trial

Please be advised
This release is from Boehringer Ingelheim Corporate Headquarters in Germany. Please be aware that there may be national differences between countries regarding specific medical information, including licensed uses. Please take account of this when referring to the information provided in this document. This press release is not intended for distribution within the U.S.A.

1 Stewart S, Murphy N, Walker A, et al. Cost of an emerging epidemic: an economic analysis of atrial fibrillation in the UK. Heart 2004;90:286-92
2 Wolf PA, Benjamin EJ, Belanger AJ, et al. Secular trends in the prevalence of atrial fibrillation: The Framingham Study. Am Heart J 1996;131:790-5
3 Benyoucef S, Hughes M, Mehta N. Atrial Fibrillation. Decision Resources, December 2008
4 Lip GHY. Does atrial fibrillation confer a hypercoagulable state? Lancet 1995;346:1313-4
5 Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA, Halperin JL, Le Heuzey JY, Kay GN, Lowe JE, Olsson SB, Prystowsky EN, Tamargo JL, Wann S. ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation – executive summary. Circulation 2006;114:700-752
6 Gladstone DJ, Bui E, Fang J, et al. Potentially preventable strokes in high-risk patients with atrial fibrillation who are not adequately anticoagulated. Stroke 2009;40:235-40
7 Rosamond W, Flegal K, Furie K, et al. Heart disease and stroke statistics – 2008 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Committee. Circulation 2008;117:e25-e146
8 Hart RG, Pearce LA, Aguilar MI, et al. Meta-Analysis: antithrombotic therapy to prevent stroke in patients who have non-valvular atrial fibrillation. Ann Intern Med 2007;146:857-67
9 Hirsh J, Dalen JE, Deykin D, et al. Oral anticoagulants. Mechanism of action, clinical effectiveness, and optimal therapeutic range. Chest 1995;108:231S-246S
10 Samsa GP, Matchar DB, Goldstein LB, et al. Quality of anticoagulation management among patients with atrial fibrillation: results of a review of medical records from 2 communities. Arch Intern Med 2000;160:967-73
11 Hylek EM, D’Antonio J, Evans-Molina C, et al. Translating the results of randomized trials into clinical practice. The challenge of warfarin candidacy among hospitalized elderly patients with atrial fibrillation. Stroke 2006;37:1075-80

Contact: Boehringer Ingelheim GmbH, Corporate Division Communications , Dr Reinhard Malin, 55216 Ingelheim , Germany, Phone: + 49 - 6132 – 77 90815
Fax: + 49 - 6132 – 77 6601, Contact

Source: Boehringer Ingelheim GmbH

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