New study from Beijing Tiantan Hospital: Efficacy and safety effects of renal function on different bispecific antibody treatment strategies in patients with acute ischemic cerebrovascular disease

Annals of Internal Medicine (IF:51.
599; The journal Division: Medical Region 1 Top) published the full online research article "Ticagrelor-Aspirin versus Clopidogrel-Aspirin among CYP2C19", with Associate Researcher Wang Anxin and Associate Chief Physician Xie Xuewei of Beijing Tiantan Hospital affiliated to Capital Medical University as the joint first authors, and Chief Physician Meng Xia and Professor Wang Yongjun as co-corresponding authors Loss-of-Function Carriers with Minor Stroke or TIA in Relation to Renal Function: A Post Hoc Analysis of CHANCE-2 Trial”
。

Renal impairment is associated with platelet dysfunction, and antiplatelet therapy can reduce the risk of blood clots in patients with renal impairment, but at the same time increase the risk of
bleeding.
This may affect the risk-benefit ratio
of antiplatelet therapy in stroke patients with renal impairment.
Therefore, it is important to
identify the optimal antiplatelet strategy for stroke patients with different renal function statuses.
The efficacy of clopidogrel plus aspirin in the treatment of acute stroke or transient ischemic attack - II (CHANCE-2) found that the use of ticagrelor plus aspirin compared with clopidogrel plus aspirin further reduced the risk of stroke recurrence in patients with at least one CYP2C19 function deletion allele, but the effect of renal function status on the risks and benefits of ticagrelor-aspirin versus clopidogrel-aspirin
。

This study is based on the CHANCE-2 study to explore the effects
of different renal function states on the efficacy and safety of bispecific antibody therapy in stroke patients.
The primary efficacy measure was stroke recurrence within 90 days, and the primary safety outcome was moderate to severe bleeding events
within 90 days.
In this study, 6,378 subjects were divided into three groups
: normal renal function, mild renal function decline, and moderate to severe renal function decline according to glomerular filtration rate 。 The results of the study showed that for the outcome of stroke recurrence, bispecific antibody therapy had a certain interaction with renal function status, and ticagrelor-aspirin bispecific antibody treatment could effectively reduce the stroke recurrence rate in patients with normal renal function compared with clopidogrel - aspirin treatment (HR, 0.
63; 95% CI, 0.
49 to 0.
81), while in mild (HR, 0.
98; 95% CI, 0.
69 to 1.
39) and patients with moderate to severe renal function decline (HR, 1.
31; 95% CI, 0.
48 to 3.
55) no significant benefit
was found.
For safety outcomes, ticagrelor-aspirin biantibody treatment did not significantly increase moderate to severe bleeding
in different renal function states.

The results of this study suggest that stroke patients with normal renal function are more likely to benefit from ticagrelor-aspirin bispecific antibody therapy, which provides a personalized guidance strategy
for assessing the patient's renal function status and bispecific antibody treatment of stroke patients when using ticagrelor-aspirin or clopidogrel-aspirin biantibody therapy in clinical practice.