One-a-day heart pill to stave off stroke is given the green light
New treatment: Hundreds of thousands of patients with atrial fibrillation could benefit from the drug. (Posed by model)
The first once-a-day anti-clotting drug for patients with an irregular heartbeat has been given the green light for use on the NHS.
Rivaroxaban works as well as warfarin, a treatment based on rat poison which has been used since the 1950s, but with fewer side effects.
Hundreds of thousands of patients with atrial fibrillation (AF) could be eligible, which may prevent 5,000 strokes a year.
The drug is the second new anti-clotting agent to get the go-ahead from the NHS rationing body, the National Institute for Health and Clinical Excellence (Nice), which recently approved Pradaxa.
AF is the most common heart rhythm disturbance, affecting up to 1.2 million Britons and causing 12,500 strokes a year.
In AF, the upper chambers of the heart are out of rhythm and beat much faster than normal, which allows blood to pool and generate tiny blood clots which can trigger a stroke.
Rivaroxaban is expected to become a blockbuster drug. As a daily pill, it has a key advantage over Pradaxa, which must be taken twice a day.
AF patients have to take anti-clotting agents for life, but Nice says the new drugs offer value for money either as a replacement for warfarin or for patients who cannot take it.
At 2.10 a day, Rivaroxaban is slightly cheaper than Pradaxa (2.50), but there is still a big price differential with warfarin. The new drug costs 64 for a month’s supply, compared to warfarin’s cost of only 1, plus clinic visits.
Some of the clinic costs associated with monitoring warfarin may be recouped, says Nice.
Warfarin, which is still used in large doses to kill vermin, has been given routinely to AF patients for decades, reducing the rate of stroke by up to two-thirds at the cost of increased bleeding.
But it is inconvenient for patients because careful monitoring and regular blood tests are needed to prevent excessive bleeding from cuts or stomach ulcers.
Poison: Many patients are currently treated with warfarin, which is used in large doses to kill vermin such as mice, meaning those using it must be monitored
A consensus conference by the Royal
College of Physicians in Edinburgh estimated 5,000 strokes and 2,000
premature deaths a year could be avoided through effective detection and
treatment of AF, with only half of patients currently receiving drugs.
Lobban, chief executive and founder of the Atrial Fibrillation
Association, said prevention and treatment of strokes should be an NHS
She added: ‘After
60 years when warfarin was the only option for patients we now have a
choice of agents that will have a significant impact on strokes and
quality of life. They are opening the way for raising awareness and
education, and encouraging GPs to check for AF.’
Rivaroxaban was developed by Bayer AG and Johnson & Johnson and is expected to make peak sales worth two billion euros a year in Europe.
Dr Peter Coleman, of The Stroke Association, said: ‘Warfarin is a highly effective treatment for stroke prevention, but it is not suitable for everyone.
‘We’re pleased to hear that GPs will have another safe medication in their armoury to treat patients with atrial fibrillation.’
Professor Carole Longson, of Nice, added: ‘We know that people taking warfarin can find it difficult to maintain their blood clotting at a proper level and are often not within the target therapeutic range.
‘Rivaroxaban, like dabigatran etexilate, which Nice recently approved as an option for this indication, can benefit people with AF in these circumstances.’