New draft guidance from the National Institute for Health and Clinical Excellence (NICE) recommends the use of AstraZeneca's anti-platelet drug Brilique (ticagrelor) in combination with aspirin as an option to treat adults with acute coronary syndromes (ACS).

ACS refers to a group of heart problems ranging from myocardial infarction (MI: heart attacks) to unstable angina, which occur due to narrowed coronary arteries. They are usually caused by coronary heart disease where cholesterol-rich deposits, or plaques, form within the walls of coronary arteries (atherosclerosis). This can cause the coronary artery to become progressively narrowed, and blood supply to the heart is affected (ischaemia).

The draft guidance also recommends Brilique in combination with aspirin as a treatment option for unstable angina in hospitalised patients who have changes on an electrocardiogram (ECG) suggestive of ischaemia and a risk factor for cardiovascular disease.

"Ticagrelor is the latest in an ever-increasing number of important new drugs and interventional techniques that have been shown to reduce deaths in patients with ACS," said Carole Longson, director of NICE's health technology evaluation centre. 

"From the evidence considered, the independent Appraisal Committee concluded that, compared with clopidogrel, reductions in MI and death from vascular causes were significant - 16% and 21% respectively - for patients randomised to the ticagrelor group. All anti-platelets, because of their mechanism of action, can cause bleeding. Importantly, the same evidence showed that there was no significant difference in the primary safety endpoint of ‘major’ bleeding between ticagrelor and clopidogrel," Dr Longson added.

NICE's provision recommendation was welcomed by Kausik Ray, professor of cardiovascular disease prevention at St George's Hospital NHS Trust Research Centre, who said it "means we are one step closer to ensuring this life-saving medicine is available for the thousands of patients in England and Wales who could benefit from its use."

Despite current treatment options, one in seven patients (14.8%) will die within 12 months following a heart attack, Prof Ray added.

AstraZeneca points out that, in the UK, there were approximately 162,000 hospital admissions for heat attack and episodes of unstable angina between 2009-2010, and that the total cost of managing heart attacks and unstable angina in the UK is around £1.5 billion a year.

Ticagrelor is approved in 35 countries, including in the European Union (EU) under the trade name Brilique and in Brazil, Canada and, most recently Australia, under the trade name Brilinta. The product currently has price approvals in 16 countries and reimbursement authorisations in seven, the company notes.

NICE's preliminary guidance on Brilique is available for public consultation on the Institute's website until July 21.