Idraparinux

Negative clinical trial

A phase III trial of idraparinux sodium for stroke prevention in patients with AF (AMADEUS) was halted prematurely due to excessive clinically relevant and intracranial bleeding. Bleedings were particularly increased in elderly patients and those with renal impairment. Sanofi discontinued the development of idraparinux sodium in favour of a biotinylated formulation of the drug called idrabiotaparinux sodium.

Method of action

Idraparinux selectively blocks coagulation factor Xa.

See Heparin: Mechanism of anticoagulant action for a comparison of the mechanism of heparin, low-molecular-weight heparins, fondaparinux and idraparinux.

{{anchor|Idrabiotaparinux}} Idrabiotaparinux

Idrabiotaparinux sodium is also administered once-weekly. It has the same pentasaccharidic structure as idraparinux sodium, but with biotin attached, which allows its neutralisation with avidin, an egg-derived protein with low antigenicity. Sanofi conducted three phase III trials of idrabiotaparinux sodium between 2006 and 2008 in approximately 13,550 patients. In one phase III trial (the BOREALIS-AF study), idrabiotaparinux sodium was non-inferior to warfarin in preventing the recurrent venous thromboembolism at three months in patients with pulmonary embolism and the incidence of clinically relevant bleeding was lower in the idrabiotaparinux sodium arm. The drug was expected to be filed for stroke prevention in patients with atrial fibrillation in 2011. The study was prematurely terminated, and the reason remains unclear. However, Sanofi has since discontinued its development. The company announced in May 2011 that the drug is available for licensing. A systematic review found that until now there is not sufficient evidence to clarify whether idraparinux or idrabiotaparinux are as effective and safe as the standard warfarin treatment for venous thromboembolism prevention. Idraparinux or idrabiotaparinux decreased major bleeding rate significantly but had a trend to increase the all-cause mortality compared with warfarin.

References

8. Supriya Dey, Hong Jay Lo and Chi Huey Wong “ An efficient Modular One pot synthesis of Heparin-Based Anticoagulant Idraparinux” J. Am. Chem. Soc. 2019, 141, 10309

References

1. (January 2008). "Comparison of idraparinux with vitamin K antagonists for prevention of thromboembolism in patients with atrial fibrillation: a randomised, open-label, non-inferiority trial". Lancet.
2. Modern anticoagulants threaten status quo http://www.pmlive.com/pharma_intelligence/modern_anticoagulants_threaten_status_quo_411610
3. The Amadeus investigators. Comparison of idraparinux with vitamin K antagonists for prevention of thromboembolism in patients with atrial fibrillation: a randomised, open-label, non-inferiority trial. Lancet 2008; 371:315-321.
4. (September 2007). "Idraparinux versus standard therapy for venous thromboembolic disease". N. Engl. J. Med..
5. Stroke Prevention in Atrial Fibrillation: Latest Clinical Trials and Guidelines Luciana Armaganijan, Dimpi Patel, [...], and Carlos A. Morillo Pharmaceuticals (Basel). Apr 2012; 5(4): 384–397 [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3763643/#!po=2.63158 doi: 10.3390/ph5040384]
6. Modern anticoagulants threaten status quo http://www.pmlive.com/pharma_intelligence/modern_anticoagulants_threaten_status_quo_411610
7. Song Y, Li X, Pavithra S, Li D (2013) Idraparinux or Idrabiotaparinux for Long-Term Venous Thromboembolism Treatment: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. PLoS ONE 8(11): e78972. [http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0078972 doi:10.1371/journal.pone.0078972]