PJ Online | News: Routine use of clopidogrel not warranted, says DTB

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The Pharmaceutical Journal
Vol 268 No 7203 p861-867
22 June 2002

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Drug and Therapeutics Bulletin (more)

Routine use of clopidogrel not warranted, says DTB

Routine use of clopidogrel (Plavix) in patients with acute coronary syndrome without ST elevation is not warranted, according to the June issue of the Drug and Therapeutics Bulletin. The results of the CURE (clopidogrel in unstable angina to prevent recurrent events) trial do not provide evidence for the use of clopidogrel in addition to conventional therapy, it says.

The CURE study, published last year, involved 12,562 patients with acute coronary syndrome who were assigned to receive either aspirin or aspirin plus clopidogrel for between three and 12 months (PJ, March 24, p382). The researchers found that adding clopidogrel to standard treatment reduced the risk of serious cardiovascular incidents by a fifth.

The bulletin says that clopidogrel might have a role in the treatment of selected patients with acute coronary syndrome at higher risk of progressing to myocardial infarction or death. However, the net benefit from long-term use in this sub-group of patients may not be worthwhile.

Whether there is a favourable benefit-harm ratio from a shorter duration of use of the treatment is not clear from data currently available. "Unless or until such information is made available, the place of clopidogrel is uncertain," the bulletin concludes.

The bulletin also comments that it is not clear how clopidogrel therapy compares with glycoprotein IIb/IIIa inhibitor therapy. It recommends that where a glycoprotein IIb/IIIa inhibitor is contraindicated in patients with acute coronary syndrome selected for percutaneous coronary intervention, "treatment with clopidogrel plus aspirin (currently an unlicensed indication) is probably a reasonable alternative" (2002;20:41).

Oxcarbazepine for epilepsy The June issue of the Drug and Therapeutics Bulletin also discusses the place of oxcarbazepine (Trileptal) in the treatment of epilepsy. The bulletin concludes that in adults and children with poorly controlled partial-onset epilepsy, add-on therapy with oxcarbazepine can reduce the frequency of seizures. Oxcarbazepine is about as effective as other add-on anti-epileptic drugs for refractory seizures, but none of the available drugs has been adequately compared for efficacy and tolerability, it says.

Careful dose titration of add-on oxcarbazepine is required because of the incidence of unwanted effects. In addition, adjustment of the dose of concomitant anti-epileptic drugs may be needed even though the potential for drug interactions with oxcarbazepine is less than with carbamazepine. The bulletin also comments that oxazepine may be an alternative for monotherapy for partial seizures when standard first-line drugs, such as carbamazepine and sodium valproate, are not tolerated (ibid, p46).