PA32540 (a coordinated-delivery tablet of enteric-coated aspirin 325 mg and immediate-release omeprazole 40 mg) versus enteric-coated aspirin 325 mg alone in subjects at risk for aspirin-associated gastric ulcers: Results of two 6-month, phase 3 studies

• Published in: The American heart journal Vol. 168; no. 4; pp. 495 - 502.e4
• Main Authors: Whellan, David J., Goldstein, Jay L., Cryer, Byron L., Eisen, Glenn M., Lanas, Angel, Miller, Alan B., Scheiman, James M., Fort, John G., Zhang, Ying, O’Connor, Christopher
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.10.2014; Elsevier Limited
• Subjects: Abdomen; Acute coronary syndromes; Anti-Ulcer Agents - administration & dosage; Aspirin; Aspirin - administration & dosage; Aspirin - adverse effects; Cardiovascular; Cardiovascular disease; Cardiovascular Diseases - drug therapy; Dose-Response Relationship, Drug; Double-Blind Method; Drug dosages; Drug therapy; Follow-Up Studies; Gastroesophageal reflux; Heart attacks; Heart failure; Incidence; Laboratories; Nonsteroidal anti-inflammatory drugs; Omeprazole - administration & dosage; Platelet Aggregation Inhibitors - administration & dosage; Platelet Aggregation Inhibitors - adverse effects; Population; Retrospective Studies; Risk Factors; Stomach Ulcer - chemically induced; Stomach Ulcer - epidemiology; Stomach Ulcer - prevention & control; Studies; Tablets, Enteric-Coated; Ulcers; United States - epidemiology; United States; United States > US
• ISSN: 0002-8703; 1097-6744; 1097-6744
• DOI: 10.1016/j.ahj.2014.05.017

Discontinuations and/or interruptions in aspirin therapy for secondary cardioprotection due to upper gastrointestinal (UGI) complications or symptoms have been shown to increase the risk for subsequent cardiovascular events. PA32540 is a coordinated-delivery, combination tablet consisting of enteric-coated aspirin (EC-ASA) 325 mg and immediate-release (IR) omeprazole 40 mg. Two identically-designed, 6-month, randomized, double-blind trials evaluated PA32540 vs. EC-ASA 325 mg in a secondary cardiovascular disease prevention population taking aspirin 325 mg daily for ≥3 months and at risk for ASA-associated gastric ulcers (GUs). The combined study population was 1049 subjects (524 randomized to PA32540, 525 to EC-ASA 325 mg). The primary endpoint was the occurrence of endoscopically-determined gastric ulceration over 6 months. Safety outcomes included the rates of major adverse cardiovascular events (MACE) and UGI symptoms. Significantly fewer PA32540-treated subjects (3.2%) developed endoscopic GUs vs. EC-ASA 325 mg-treated subjects (8.6%) (P < .001). Overall occurrence of MACE was low (2.1%), with no significant differences between treatments in types or incidence of MACE. PA32540-treated subjects had significantly fewer UGI symptoms (P < .001) and significantly fewer discontinuations due to pre-specified UGI adverse events (1.5% vs. 8.2%, respectively; P < .001). PA32540 reduced the incidence of endoscopic GUs compared to EC-ASA 325 mg, but with a similar cardiovascular event profile. Due to fewer UGI symptoms, continuation on aspirin therapy was greater in the PA32540 treatment arm.