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Yosprala for secondary prevention of cardiovascular and cerebrovascular events in patients at risk for Aspirin-associated gastric ulcers, approved by FDA


The U.S. Food and Drug Administration ( FDA ) has approved once-daily Yosprala, the only prescription fixed-dose combination of Aspirin, an anti-platelet agent, and Omeprazole, a proton pump inhibitor ( PPI ) in the U.S.
Yosprala is indicated for patients who require Aspirin for secondary prevention of cardiovascular and cerebrovascular events and who are at risk of developing Aspirin associated gastric ulcers.

Daily Aspirin is a standard of care for secondary cardiovascular event prevention, but gastrointestinal symptoms are often cited as the reason patients stop taking this important therapy. Discontinuation of daily Aspirin therapy for secondary prevention can pose a significant cardiovascular risk.
Published research shows that patients who have or are at risk of coronary artery disease and discontinue daily Aspirin treatment have a three-fold higher risk of a major adverse cardiac event, including death, shortly after stopping therapy.
Another study documented that Aspirin discontinuation following a gastrointestinal bleed in patients with cardiovascular disease increases the risk of a cardiovascular event or death almost 7-fold.

Yosprala is designed to support both cardio- and gastro-protection for at-risk patients through the proprietary Intelli-COAT system, which is formulated to sequentially deliver immediate-release Omeprazole ( 40 mg ) followed by a delayed-release, enteric-coated Aspirin core in either 81 mg or 325 mg dose strengths.
The immediate-release Omeprazole is designed to elevate the gastric pH into a gastroprotective zone. The enteric-coated Aspirin dissolves after the pH has been elevated to greater than or equal to 5.5, within the gastroprotective zone, thereby reducing stomach ulcer risk.

Up to an estimated 26.2 million adults in the U.S. are at risk for secondary cardiovascular events. The occurrence of secondary cardiovascular events among people with heart disease continues to be a significant problem in the U.S.
Patients who have experienced a myocardial infarction have an elevated cardiovascular risk within the first six years of that first event, equating to an estimated 200,000 Americans a year who go on to have a second heart attack.

Recent guidelines from the American College of Cardiology ( ACC ) and American Heart Association ( AHA ) affirm the importance of daily Aspirin therapy.
Daily Aspirin therapy, however, can cause gastrointestinal symptoms and damage, such as gastroesophageal reflux disease, gastric ulcers and even gastrointestinal bleeding, through both direct and indirect mechanisms.

A 2008 Expert Consensus Task Force specifically examined ways to reduce the gastrointestinal risks of antiplatelet therapy and nonsteroidal anti-inflammatory drugs ( NSAID ) use including Aspirin. The findings included data which demonstrated that gastrointestinal risk may occur regardless of Aspirin dose or formulation, meaning low-dose, buffered and enteric-coated Aspirin preparations may not be gastrointestinal protective.
The Task Force also devised an algorithm for the prevention and treatment of Aspirin and NSAID-related gastroduodenal injury. PPI therapy is believed to reduce the risk in all patients and was a proposed strategy for gastroprotection.

In the randomized controlled trials, Yosprala outperformed enteric-coated aspirin in terms of the primary endpoint, reduction in gastric ulceration, with higher adherence in patients at higher risk for Aspirin-associated gastric ulcerations, a secondary endpoint.
Over one third of patients who should be taking Aspirin for secondary prevention discontinue Aspirin due in part to gastrointestinal symptoms and that this discontinuation increases the risk of death and recurrent myocardial infarctions.

The FDA approval of Yosprala was based on the results from two randomized, double-blind controlled clinical trials that patients were randomly assigned to receive either Yosprala 325 mg/40 mg ( n=524 ) or 325 mg of enteric-coated Aspirin ( n=525 ).
Each study achieved its individual primary endpoint with patients in the Yosprala arm experiencing significantly fewer endoscopic gastric ulcers compared to those taking enteric-coated Aspirin ( 325 mg ) alone.
In addition, significantly fewer patients treated with Yosprala discontinued therapy because of prespecified upper gastrointestinal adverse events compared to patients in the enteric-coated Aspirin ( 325 mg ) arm.
The most common adverse reactions reported in adults ( incidence greater than or equal to 2% and greater than 325 mg EC Aspirin ) during the studies were gastritis, nausea, diarrhea, gastric polyps and non-cardiac chest pain. ( Xagena )

Source: Aralez Pharmaceuticals, 2016

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