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The Lancet Publishes Major Phase 3 Study on Novel Oral Direct Thrombin Inhibitor
Date:9/13/2007

Study results outline dabigatran etexilate as potential thromboprophylaxis

therapy for patients undergoing total hip replacement surgery

RIDGEFIELD, Conn., Sept. 13 /PRNewswire/ -- Boehringer Ingelheim today announced that the September 15 issue of The Lancet will publish results from the RE-NOVATE study, which investigated dabigatran etexilate as a potential therapy for patients undergoing total hip replacement surgery(1). The results from this study demonstrate that both doses (220mg and 150mg) of the oral direct thrombin inhibitor, dabigatran etexilate, administered for a median of 33 days, were non-inferior to injectable enoxaparin in reducing the risk of venous thromboembolism (VTE) after total hip replacement surgery with similar safety.

The primary endpoint of this trial was a composite consisting of total venous thromboembolic events and all-cause mortality during treatment, which occurred in 6.0% of the 220mg group and 8.6% of the 150mg group taking dabigatran etexilate, versus 6.7% of the enoxaparin group. Importantly, a pre-specified secondary outcome of major venous thromboembolism and venous thromboembolism-related mortality was also similar between groups, occurring in 3.1% of the 220mg group and 4.3% of the 150mg group taking dabigatran etexilate, versus 3.9% of the enoxaparin group.

Anticoagulation-related bleeding is the primary safety concern during hip replacement surgery, since major bleeding into the replaced joint can have a detrimental impact on clinical outcome(2). Generally, few major bleeding events were reported, occurring at 2.0% in the 220mg group and 1.3% in the 150mg group for dabigatran etexilate, versus 1.6% in the enoxaparin group. Notably about half of all major bleeding events started after surgery and before the first dose of dabigatran etexilate. There were no major bleeding events reported after hospital discharge in the dabigatran etexilate groups.

Data from frequent liver function monitoring showed that the frequency of increases in liver enzyme concentrations with dabigatran etexilate is low during the entire extended treatment period. Results showed that alanine aminotransferase (ALT) elevation greater than three times the upper limit of normal occurred in 5.3% enoxaparin group, as compared to 3.0% in the 150mg group and 3.0% in the 220mg group taking dabigatran etexilate. Similarly, the incidence of acute coronary events was low, with no significant differences between all groups.

Current treatment guidelines recommend that patients undergoing knee or hip replacement surgery receive thromboprophylaxis (treatment to prevent VTE) with low molecular weight heparin (LMWH), fondaparinux or warfarin for at least 10 days after surgery. For patients undergoing hip replacement surgery, extended thromboprophylaxis for up to 28-35 days is recommended.(3) The RE- NOVATE study was designed consistent with these guidelines.

About dabigatran etexilate

Dabigatran etexilate is an investigational oral direct thrombin inhibitor that specifically and reversibly inhibits thrombin, the key enzyme for blood clot formation, and is currently in phase 3 development. In the RE-NOVATE study, dabigatran etexilate was dosed once a day without routine coagulation monitoring. Patients in the study received a fixed dose of dabigatran etexilate and were not titrated during the duration of the study.

Further studies investigating dabigatran etexilate

Dabigatran etexilate is being investigated in multiple phase 3 trials that are designed to investigate the oral direct thrombin inhibitor as a potential treatment and prophylaxis for several thromboembolic disease conditions. The phase 3 clinical trial program is expected to involve more than 27,000 patients from Asia, Australia, Europe, the Americas, and South Africa.

Boehringer Ingelheim Pharmaceuticals, Inc.

Boehringer Ingelheim Pharmaceuticals, Inc., based in Ridgefield, CT, is the largest U.S. subsidiary of Boehringer Ingelheim Corporation (Ridgefield, CT) and a member of the Boehringer Ingelheim group of companies.

The Boehringer Ingelheim group is one of the world's 20 leading pharmaceutical companies. Headquartered in Ingelheim, Germany, it operates globally with 137 affiliates in 47 countries and approximately 38,400 employees. Since it was founded in 1885, the family-owned company has been committed to researching, developing, manufacturing and marketing novel products of high therapeutic value for human and veterinary medicine.

In 2006, Boehringer Ingelheim posted net sales of US $13.3 billion (10.6 billion euro) while spending approximately one-fifth of net sales in its largest business segment, Prescription Medicines, on research and development. For more information, please visit http://us.boehringer-ingelheim.com.

References

1. Lancet ref

2. Lotke PA, Lonner JH. Deep venous thrombosis prophylaxis: better living

through chemistry-in opposition. J Arthroplasty 2005;20:15-7

3. Geerts WH, Pineo GF, Heit JA et al. Prevention of Venous

Thromboembolism: The Seventh ACCP Conference on Antithrombotic and

Thrombolytic Therapy. Chest 2004;126:338-400


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SOURCE Boehringer Ingelheim
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