- Phase 3 VOYAGER PAD is the first investigational study in 20 years to highlight the benefit of long-term treatment in these high-risk patients
- Data add to growing body of evidence on the role of dual pathway inhibition in targeting both thrombin generation and platelets
The Janssen Pharmaceutical Companies of Johnson & Johnson today presented new data from the Phase 3 VOYAGER PAD study which showed XARELTO® (rivaroxaban) (2.5 mg twice daily) in combination with aspirin (100 mg once daily) consistently reduced severe vascular events in patients with peripheral artery disease (PAD) after lower-extremity revascularization (LER) compared to aspirin alone regardless of whether it was the first, second, third, or subsequent event. The primary results of VOYAGER PAD showed that XARELTO® plus aspirin reduced first events by 15 percent among patients with PAD after LER. This analysis showed a very high burden of subsequent events and a consistent 14 percent reduction in both primary endpoint events and total vascular events over a median of 2.5 years. These data were presented as a late-breaking presentation during the virtual American College of Cardiology’s 70th Annual Scientific Session (ACC.21) and simultaneously published in the Journal of the American College of Cardiology.
PAD is a chronic circulatory condition which causes blood vessels to narrow, thereby reducing blood flow to the limbs, most often the legs. An estimated 20 million Americans are living with PAD, but only 8.5 million are currently diagnosed.2 While usually starting as asymptomatic, PAD symptoms can progress to severe and require revascularization to avoid amputation.
“Even years after revascularization, patients with PAD continue to have a markedly high-risk for future thrombotic events due to excessive thrombin generation and platelet aggregation,” said Marc P. Bonaca*, M.D., Department of Medicine, Division of Cardiovascular Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado. “This analysis from VOYAGER PAD looked beyond the first event and found subsequent thrombotic event reduction with rivaroxaban plus aspirin, underscoring the importance of long-term prevention in these high-risk patients.”
In addition to evaluating the time to first event, this sub-analysis from VOYAGER PAD also evaluated thrombotic events that occurred after the first event. Specifically, it showed XARELTO® plus aspirin significantly reduced total primary endpoint events (acute limb ischemia, major amputation for vascular causes, non-fatal myocardial infarction, non-fatal ischemic stroke, or death from vascular causes) compared to aspirin alone (Hazard Ratio (HR)=0.86, 95% Confidence Internal (CI) 0.75 to 0.98; p=0.02). The XARELTO® plus aspirin regimen also significantly reduced total vascular events (all primary endpoints plus subsequent peripheral revascularizations of both index and contralateral leg and venous thromboembolic events) compared to aspirin alone (HR 0.86, 95% CI 0.79 to 0.95; p=0.003). No significant increase in Thrombolysis in Myocardial Infarction (TIMI) major bleeding was observed in the VOYAGER PAD study in patients treated with XARELTO® plus aspirin compared to aspirin alone (2.65% vs. 1.87% respectively; HR=1.43, 95% CI, 0.97–2.10; p=0.07).
