Research and Therapeutic Nihilisms in Chronic Kidney Disease.

Marc Laine (1) , Stéphane Burtey (2) , Etienne Puymirat (3) , Gilles Lemesle (2) , Laurent Bonello (2)

1 Departement de cardiologie
2 VRCM - Vascular research center of Marseille
3 HEGP - Hôpital Européen Georges Pompidou [APHP]

We congratulate Baber et al. (1) for their new analysis of the PROMETHEUS registry. Large real-life registries are critical to confirm the efficacy and safety of new drugs and provide data for key subgroups of patients who are under-represented in clinical trials (CT). Although patients with chronic kidney disease (CKD) compose between 20% and 40% of acute coronary syndromes, they were under-represented in the PLATO (Study of Platelet Inhibition and Patient Outcomes) and TRITON-TIMI 38 (Trial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet Inhibition with Prasugrel-Thrombolysis in Myocardial Infarction 38) trials. In the present study, Baber et al. (1) investigated the real-life outcome of prasugrel compared with clopidogrel in acute coronary syndromes undergoing percutaneous coronary intervention based on kidney function. They identified a lower use of prasugrel in this high ischemic risk population. This is related to therapeutic nihilism, which is well recognized in patients with CKD. Another key result is the lack of significant difference in outcomes after adjustments between prasugrel and clopidogrel (1). However, it should be acknowledged that this lack of significant difference does not imply a lack of benefit of new P2Y12-ADP receptor antagonists given the limited power of the analysis and the methodology.

Domaines: Cardiologie et système cardiovasculaire; Urologie et Néphrologie; Pharmacologie; Santé publique et épidémiologie

Marc Laine, Stéphane Burtey, Etienne Puymirat, Gilles Lemesle, Laurent Bonello. Research and Therapeutic Nihilisms in Chronic Kidney Disease.. JACC: Cardiovascular Interventions, 2017, 10 (22), pp.2343-2344. ⟨10.1016/j.jcin.2017.08.038⟩. ⟨hal-01771171⟩