The quest for an anticoagulant that can prevent cardiovascular events without bleeding is something of a holy grail in cardiovascular medicine. Could factor XI inhibitors be the long-sought answer?
Ruff noted that the biggest need for new anticoagulants in general is in the AF population."Atrial fibrillation is one of the most common medical conditions in the world. Approximately 1 in every 3 people will develop AF in their lifetime, and it is associated with more than a fivefold increased risk of stroke. But up to half of patients with AF currently do not take anticoagulants because of concerns about bleeding risks, so these patients are being left unprotected from stroke risk.
"While we are pretty sure that factor XI inhibitors will cause less bleeding than current anticoagulants, what is unknown still is how effective they will be at preventing pathologic blood clots," Alexander points out. . And we know from the DOACs that the doses preventing clots on the venous side also translated into preventing strokes on the AF side. So that is very encouraging," Ruff adds.The three leading factor XI inhibitors have slightly different phase 3 development programs.
Ruff points out that anticoagulants currently do not have a large role in the post-stroke or post-ACS population.
The three factor XI inhibitors also have some differences. Ruff points out that most important will be the safety and efficacy of the drugs in phase 3 trials. Ruff says that the AZALEA phase 2 study will provide some data on patients being managed around procedures."The hope is that that these drugs are so safe that they will not have to be stopped for procedures. And then the compliance issue of a once-a-month dosing would be an advantage."
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