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NEW DRUG DEVELOPMENTS

Cangrelor for Treatment of Coronary Thrombosis

Associate Professor, College of Pharmacy, University of Oklahoma, Oklahoma City, OK

Laura A Cudd, Pharm PhD

Anticoagulation Clinic Provider, Integris Southwest Medical Center Anticoagulation Clinic, Oklahoma City

Reprints: Dr. Fugate, College of Pharmacy, University of Oklahoma, 1110 N. Stonewall, PO Box 26901, Oklahoma City, OK 73190-5040, fax 405/271-6430, susan-fugate{at}ouhsc.edu

OBJECTIVE: To review and assess available literature on the chemistry, pharmacology, pharmacodynamics, pharmacokinetics, clinical studies, adverse events, drug interactions, special populations, and dosing and administration for cangrelor, a product in late stage Phase II clinical trials.

DATA SOURCES: A literature search of MEDLINE (1966-March 2006), International Pharmaceutical Abstracts (1970-February 2006), and Cochrane database (first quarter 2006) was conducted using key terms of cangrelor, AR-C69931MX, and P2Y₁₂ receptor antagonist. Bibliographies of relevant articles were reviewed for additional references. The Medicines Company Web site was reviewed, and a company representative was contacted.

STUDY SELECTION AND DATA EXTRACTION: Available English-language literature, including abstracts, preclinical studies, clinical trials, and review articles, was reviewed.

DATA SYNTHESIS: Cangrelor is a P2Y₁₂ antagonist under development for treatment of acute coronary syndrome. Cangrelor has been studied as an intravenous infusion in doses of 2 or 4 µg/kg/min. It inhibits platelet aggregation with rapid onset and offset and does not require metabolism for therapeutic activity. Published Phase II trials have demonstrated safety and inhibition of platelet aggregation.

CONCLUSIONS: Cangrelor is a promising investigational medication for inhibition of platelet aggregation in acute arterial coronary events. Phase II trials have shown safety and a greater inhibition of platelet aggregation over clopidogrel. Phase III trials will provide more definitive information on clinical efficacy and safety. Until then, the role of cangrelor is uncertain.

Key Words: AR-C69931MX, ATP analog, cangrelor, P2Y₁₂ receptor antagonist

Published Online, April 4, 2006. www.theannals.com, DOI 10.1345/aph.1G120

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