A recent subgroup analysis of the OCEANIC-AF trial sought to answer an important clinical question: for patients with atrial fibrillation, does a history of prior oral anticoagulant (OAC) use affect how they respond to a new medication? To find out, researchers, including the CVC’s Drs. Shaun Goodman and Roopinder Sandhu, compared the new anticoagulant therapy asundexian to the current standard of care, apixaban, to determine if the risk-benefit profile differed between “OAC-naive” and “OAC-experienced” patients.
The analysis confirmed that a patient’s prior medication history was indeed an important determinant of the drug’s performance. Among OAC-naive patients, the increased risk of stroke or systemic embolism with asundexian (an experimental OAC) versus apixaban was less pronounced than in OAC-experienced patients. With regards to safety, the risk of bleeding was lower with asundexian than with apixaban, a benefit that was consistent across both patient subgroups.
These results pinpoint OAC-naive patients as a potentially key group for the future evaluation of this new class of drugs, and have already helped guide the planning of an upcoming phase 2 trial Dr. Goodman and newest CVC faculty member Dr. Pishoy Gouda are pursuing with another novel OAC. Why these patient groups responded differently is still unknown, highlighting a critical direction for future research.
