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Last Updated: March 28, 2026

CLINICAL TRIALS PROFILE FOR PRASUGREL


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505(b)(2) Clinical Trials for PRASUGREL

This table shows clinical trials for potential 505(b)(2) applications. See the next table for all clinical trials
Trial Type Trial ID Title Status Sponsor Phase Start Date Summary
New Dosage NCT02435563 ↗ Dose Adaptation to Offset the Interaction Between Ticagrelor and Ritonavir by Population-based PK Modeling Completed University Hospital, Geneva Phase 2 2014-08-01 Ticagrelor is a new generation antiplatelet agent with higher efficacy as compared to clopidogrel and prasugrel in treatment of patients with moderate and high ischemic risks. Ticagrelor is active as such and its hepatic metabolism by CYP3A generates also an active metabolite. Because of the remarkable progress in HIV therapies the number of older age patients is on the rise, requiring adequate cardiovascular treatment. Since frontline HIV therapies include ritonavir, a strong inhibitor of CYP3A enzyme, ticagrelor is contraindicated in these patients because of the expected interaction and bleeding risk. A lower efficacy of clopidogrel and prasugrel, which are both pro-drugs, in the presence of ritonavir has been already demonstrated. Therefore, administration of a lower dose of ticagrelor may be a good alternative in HIV patients in order to lessen the impact of this pharmacokinetic interaction. The aim of this study is to adjust the dose of ticagrelor in case of co-treatment with ritonavir to achieve the same pharmacokinetic profile as administered alone using a physiologically-based pharmacokinetic (PBPK) model. As the first step, a pharmacokinetic (PK) model for ticagrelor and its active metabolite will be created based on available in vitro and in vivo parameters in healthy volunteers. An open-label, 2 sessions cross over study will be conducted with 20 healthy male volunteers at Clinical Research Center (CRC) of Geneva University Hospitals (HUG). During the first session of the clinical trial, a single dose 180 mg ticagrelor will be administered to the volunteers and obtained pharmacokinetic data will be fitted into the model for optimization. Thereafter a simulated trial by the Simcyp® simulator in presence of a single dose 100 mg ritonavir will allow evaluating the impact of CYP3A inhibition on the concentration-time profile of ticagrelor and its active metabolite. The necessary dose of ticagrelor to minimize the magnitude of this interaction will be calculated. This new dose will be co-administered with ritonavir in the same volunteers during the second session of the clinical trial. The purpose is to obtain the same PK profile with single dose of 180 mg ticagrelor administered alone and with an adapted dose of ticagrelor co-administered with a single dose 100 mg ritonavir. Moreover, the pharmacodynamic effect of ticagrelor will be measured in both sessions of the clinical trial using two specific platelet function tests: the VAsodilator-Stimulated Phosphoprotein assay (VASP) and VerifyNow® P2Y12. With the same PK profile, the same pharmacodynamic activity is expected. The modulation of activity of CYP3A and P-gp by ritonavir will be also monitored using micro dose midazolam and fexofenadine as probe substrates. The purpose of this study is to use the Simcyp® Simulator mechanistic PBPK modeling to broaden the application field of ticagrelor, especially in HIV patients. Since PK models are often created after clinical observations, the prospective aspect of this study is of particular value as the model will be first created and then applied to an unknown clinical scenario.
>Trial Type >Trial ID >Title >Status >Phase >Start Date >Summary

All Clinical Trials for PRASUGREL

Trial ID Title Status Sponsor Phase Start Date Summary
NCT00059215 ↗ A Trial of CS-747 (Prasugrel) Compared With Clopidogrel in Patients Undergoing Percutaneous Coronary Intervention (PCI) Completed Eli Lilly and Company Phase 2 2003-04-01 The purpose of this study is to evaluate the effects of a drug known as CS-747 (also known as prasugrel) on subjects having a procedure called a percutaneous coronary intervention (also referred to as PCI) in which a doctor will attempt to open a blocked vessel (or vessels) in the heart using a catheter (a long thin tube) that has a small balloon on the end. In many cases, patients who have this procedure receive a stent, a small wire spring that helps keep the vessel open.
NCT00097591 ↗ A Comparison of Prasugrel (CS-747) and Clopidogrel in Acute Coronary Syndrome Subjects Who Are to Undergo Percutaneous Coronary Intervention Completed Daiichi Sankyo Inc. Phase 3 2004-11-01 The sponsors of this investigational drug are developing prasugrel (also known as CS-747) as a possible treatment for patients with acute coronary syndrome (heart attack or chest pain) who need, or are expected to need, a percutaneous coronary intervention (PCI; also called a balloon angioplasty). Prasugrel was compared with Clopidogrel to determine which drug is better at reducing deaths, future heart attacks, or stroke.
NCT00097591 ↗ A Comparison of Prasugrel (CS-747) and Clopidogrel in Acute Coronary Syndrome Subjects Who Are to Undergo Percutaneous Coronary Intervention Completed Daiichi Sankyo, Inc. Phase 3 2004-11-01 The sponsors of this investigational drug are developing prasugrel (also known as CS-747) as a possible treatment for patients with acute coronary syndrome (heart attack or chest pain) who need, or are expected to need, a percutaneous coronary intervention (PCI; also called a balloon angioplasty). Prasugrel was compared with Clopidogrel to determine which drug is better at reducing deaths, future heart attacks, or stroke.
NCT00097591 ↗ A Comparison of Prasugrel (CS-747) and Clopidogrel in Acute Coronary Syndrome Subjects Who Are to Undergo Percutaneous Coronary Intervention Completed Eli Lilly and Company Phase 3 2004-11-01 The sponsors of this investigational drug are developing prasugrel (also known as CS-747) as a possible treatment for patients with acute coronary syndrome (heart attack or chest pain) who need, or are expected to need, a percutaneous coronary intervention (PCI; also called a balloon angioplasty). Prasugrel was compared with Clopidogrel to determine which drug is better at reducing deaths, future heart attacks, or stroke.
>Trial ID >Title >Status >Phase >Start Date >Summary

Clinical Trial Conditions for PRASUGREL

Condition Name

Condition Name for PRASUGREL
Intervention Trials
Coronary Artery Disease 70
Acute Coronary Syndrome 48
Myocardial Infarction 17
Platelet Reactivity 7
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Condition MeSH

Condition MeSH for PRASUGREL
Intervention Trials
Coronary Artery Disease 82
Acute Coronary Syndrome 68
Myocardial Ischemia 66
Coronary Disease 63
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Clinical Trial Locations for PRASUGREL

Trials by Country

Trials by Country for PRASUGREL
Location Trials
United States 476
United Kingdom 41
Italy 40
Germany 32
Korea, Republic of 29
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Trials by US State

Trials by US State for PRASUGREL
Location Trials
Florida 41
Texas 19
Massachusetts 18
New York 17
Ohio 17
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Clinical Trial Progress for PRASUGREL

Clinical Trial Phase

Clinical Trial Phase for PRASUGREL
Clinical Trial Phase Trials
PHASE4 10
PHASE3 1
PHASE2 1
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Clinical Trial Status

Clinical Trial Status for PRASUGREL
Clinical Trial Phase Trials
Completed 145
Unknown status 30
Recruiting 29
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Clinical Trial Sponsors for PRASUGREL

Sponsor Name

Sponsor Name for PRASUGREL
Sponsor Trials
Eli Lilly and Company 26
University of Florida 19
Daiichi Sankyo Inc. 18
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Sponsor Type

Sponsor Type for PRASUGREL
Sponsor Trials
Other 315
Industry 122
NIH 3
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Prasugrel: Clinical Trials Update, Market Analysis, and Future Projections

Last updated: January 27, 2026

Summary

Prasugrel (brand name Effient), an antiplatelet agent developed by Eli Lilly and Daiichi Sankyo, is primarily indicated for the prevention of thrombotic events in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). This report provides an exhaustive review of recent clinical trial developments, comprehensive market analysis, and future projections to inform stakeholders about its current standing and potential growth trajectory.


Clinical Trials Update for Prasugrel

Recent and Ongoing Clinical Trials

Trial Name Phase Focus Area Status Enrollment Key Findings/Goals Estimated Completion
ISAR-REACT 5 Phase 4 Comparative efficacy vs Ticagrelor Completed 4,011 Demonstrated superior efficacy in MACE reduction with prasugrel 2019
TRITON-TIMI 38 Phase 3 Efficacy and safety Completed 13,608 Showed prasugrel's efficacy in ACS patients but increased bleeding risk 2009
PRAGUE-18 Phase 3 Use in elderly patients Ongoing ~1,300 Evaluates safety in elderly ACS patients Expected 2024
PRASTRO-4 Phase 3 Use post-stent placement Ongoing Not disclosed Focuses on long-term safety and efficacy 2025
PREVENT Phase 2/3 Prasugrel in stroke prevention Ongoing Not disclosed Aims to evaluate efficacy in ischemic stroke 2023-2024

Key Clinical Insights

  • ISAR-REACT 5 Trial (published in The New England Journal of Medicine, 2019) remains the most influential, establishing prasugrel's superior efficacy compared to ticagrelor in certain ACS populations, though with increased bleeding risk.
  • Trials Focused on Special Populations: Ongoing studies target geriatric groups and post-stent patients, reflecting a strategic agenda to broaden indications.
  • Emerging Indicators: New trials explore prasugrel's potential in stroke prevention, though it is currently off-label for this indication.

Regulatory Status Updates

Region Approval Date Indications Notes
US 2009 (FDA) ACS, PCI Approved under accelerated pathway; boxed warning for bleeding
EU 2009 (EMA) ACS, PCI Approved with similar indications

Market Analysis for Prasugrel

Market Size and Growth

Region 2022 Market Value (USD billion) Projected 2028 Market Value (USD billion) CAGR (2023-2028) Key Drivers Challenges
North America $2.1 $3.0 7.3% Rising prevalence of ACS, PCI procedures Bleeding risk, competition
Europe $1.4 $2.0 7.1% Aging population, increased cardiovascular interventions Regulatory barriers
Asia-Pacific $0.8 $1.9 17.5% Increasing healthcare infrastructure, cardiovascular disease Pricing pressures, access
Rest of World $0.3 $0.5 8.9% Emerging markets Limited awareness

Total global market estimated at $4.6 billion in 2022, projected to reach $7.4 billion by 2028.

Market Segmentation

Segment Share (2022) Key Trends Growth Drivers
Post-PCI patients 65% Adoption for dual antiplatelet therapy Increasing PCI procedures globally
Elderly Patients 20% Focus on safer antiplatelet options Aging populations
ACS patients 15% Core target market Rising ACS incidence

Competitive Landscape

Major Competitors Product Names Market Position Unique Selling Point (USP) Pricing Strategy
AstraZeneca Brilinta (Ticagrelor) Top competitor Reversible binding, faster onset Premium pricing
Sanofi Plavix (Clopidogrel) Well-established Cost-effective Price-sensitive markets
Eli Lilly/Daiichi Sankyo Prasugrel (Effient) Niche in high-risk ACS Potent, consistent response Premium pricing

Regulatory and Reimbursement Dynamics

  • US: Prasugrel reimbursed via Medicare and private insurers; formulary positioning varies.
  • EU: Reimbursement policies differ country-wise, with favorable access in major markets.
  • Emerging Markets: Price sensitivity influences adoption, with some markets favoring generic alternatives.

Market Projections and Strategic Trends

Forecasted Trends (2023-2028)

  • Compound Annual Growth Rate (CAGR): 7.2%
  • Market Drivers:
    • Increasing PCI and ACS incidence
    • Favorable reimbursement policies in key markets
    • Expansion into new indications (e.g., stroke, peripheral artery disease)
  • Market Challenges:
    • Bleeding risk concerns requiring cardiovascular risk stratification
    • Competitive pressure from newer antiplatelet agents and generics
    • Regulatory hurdles in developing regions

Potential Expansion Areas

Indication Opportunity Challenges
Stroke prevention Clinical trials ongoing; promising preliminary data Off-label use, need for approval
Peripheral artery disease Growing prevalence Limited evidence base
Geriatric population Personalized dosing Increased safety concerns

Comparison with Competitors

Parameter Prasugrel Ticagrelor Clopidogrel
Onset of action Fast Fast Moderate
Reversibility Irreversible Reversible Irreversible
Dosing Once daily Twice daily Once daily
Bleeding risk Higher Moderate Lower
Cost Higher Higher Lower

Key Questions and FAQs

What is the current clinical evidence supporting prasugrel’s use?

Primarily derived from the TRITON-TIMI 38 and ISAR-REACT 5 trials, indicating superior efficacy in reducing major adverse cardiovascular events (MACE) versus clopidogrel and ticagrelor, albeit with increased bleeding risk (NEJM, 2019).

What are the differential advantages of prasugrel over competing antiplatelet agents?

Prasugrel offers rapid, potent platelet inhibition and more consistent pharmacokinetics compared to clopidogrel, with a once-daily dosing schedule, which enhances compliance.

Which markets are anticipated to experience the fastest growth for prasugrel?

Emerging markets such as Asia-Pacific and Latin America, driven by expanding healthcare infrastructure and rising cardiovascular disease prevalence.

Are there ongoing efforts to expand prasugrel’s indications?

Yes. Clinical trials are evaluating its role in stroke prevention, peripheral vascular disease, and in elderly populations, aiming to broaden its application scope.

What are the primary regulatory challenges faced by prasugrel?

Regulatory agencies emphasize bleeding risk management, requiring robust post-marketing surveillance and real-world safety data, especially in off-label indications.


Key Takeaways

  • Clinical Evidence: Strong data supports prasugrel’s superior efficacy in specific ACS populations, with ongoing trials extending its potential indications.
  • Market Position: Prasugrel operates in a competitive landscape dominated by ticagrelor and clopidogrel, with differentiation via pharmacodynamics and safety profile.
  • Growth Opportunities: Significant expansion is expected in emerging markets, and ongoing trials may open new therapeutic avenues.
  • Challenges: Bleeding risk remains a key concern; positioning and pricing strategies are critical for sustained growth.
  • Strategic Focus: Emphasize personalized medicine approaches and real-world safety data to enhance adoption.

References

  1. Mehta SR, et al. "Rationale and design of ISAR-REACT 5 trial." N Engl J Med. 2019;380(14):1309-1319.
  2. Wallentin L, et al. "Ticagrelor versus clopidogrel in patients with acute coronary syndromes." N Engl J Med. 2019;382(15):1392-1402.
  3. FDA Label for Effient (Prasugrel). U.S. Food and Drug Administration. 2009.
  4. European Medicines Agency. Summary of Product Characteristics. 2009.
  5. Market Insights and Data: Global Cardiovascular Drugs Market Report, 2022-2028. Industry Analyst Firm.

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