Dissolvable ticagrelor tablet equally effective as standard
Platelet inhibition with ticagrelor in an orodispersible tablet was similar to its standard coated form in patients with ACS undergoing PCI, according to results of the TASTER trial.

According to the researchers, with the recent availability of the ticagrelor 90 mg orodispersible tablet (ODT), which disperses upon contact in the oral cavity and releases its components before being swallowed, questions remain as to whether ODT might be an effective alternative to the standard oral administration in high-risk patients with ACS.

In the randomized TASTER trial researchers tested the platelet inhibition of a 180-mg ticagrelor loading dose of an ODT compared with a 180 mg standard coated tablet (SCT) in patients with ACS undergoing PCI.

Researchers randomly assigned patients presenting within 12 hours of symptom onset with STEMI or very high-risk non-STEMI to 180 mg ticagrelor loading dose as ODT or SCT. Water was used with SCT administration, but generally not with ODT administration.

Baseline characteristics were comparable between treatment strategies, aside from a higher rate of male patients in the ODT arm (88% vs. 74%).

Of the 130 enrolled patients, 74 presented with STEMI, and 16 patients in each group received morphine. Ninety percent of patients received the ticagrelor loading dose in the catheterization laboratory.

The study’s primary endpoint, median 1-hour platelet reactivity units (PRU), was similar between groups (ODT, 92; SCT, 140), as was the rate of patients with high residual platelet reactivity 1 hour after loading dose. Furthermore, residual platelet reactivity was similar between groups at hours 2, 4 and 6.

In a prespecified subgroup analysis of patients with STEMI, median 1-hour PRU did not differ between the groups (ODT, 147; SCT, 151). Among patients treated with morphine, no difference in 1-hour residual platelet reactivity was reported.

Independent predictors of 1-hour high residual platelet reactivity were morphine use and baseline PRU value. Event rates were comparable between groups and no patient experienced Bleeding Academic Research Consortium (BARC) greater than type 2 bleeding.

“In critically ill patients, such as a relevant proportion of those with an ACS, the use of oral pharmacological agents needing water for pill swallowing might not represent an ideal drug administration route,” the researchers wrote. “In particular, in the ambulance, emergency department or catheterization laboratory, where the speed of action is pivotal for patient management, drinking water might not be promptly available or may be technically difficult. Thus, ODT use offers a safe, effective and convenient alternative way of ticagrelor administration in patients with ACS.”

Source: https://www.jacc.org/doi/10.1016/j.jacc.2021.05.015