Edoxaban pivotal trial shows VTE efficacy, safety

It appears that the Hokusai-VTE results proved the hypothesis that edoxaban is noninferior to warfarin, and also important was that in higher-risk patients with significant pulmonary embolisms, edoxaban was better.

The emergence of the oral factor X inhibitors is giving physicians a new option for treatment. These drugs are much more convenient to use than warfarin; diet does not interfere with treatment, and blood draws aren’t necessary. It looks like the benefits from the new factor X inhibitors may be class effects; the results have been consistent from one drug to the next. But there is the limitation right now of their relatively high cost. I hope that eventually the cost differential won’t be as prohibitive as it probably is today for some patients.

Physicians and patients in the United States are slowly starting to use these drugs routinely in patients with VTE, and in other settings, such as to prevent clot formation and strokes in patients with atrial fibrillation. In mid-2013, about 10%-12% of patients with atrial fibrillation are being treated with one of the new oral anticoagulants, a group of drugs that also includes dabigatran (Pradaxa). I think there will gradually be increasing use of these drugs in place of warfarin as people grow more familiar and comfortable with them.

Dr. William A. Zoghbi is professor of medicine and director of the Cardiovascular Imaging Institute at the DeBakey Heart and Vascular Center of Methodist Hospital in Houston. He said that he had no relevant disclosures. Dr. Zoghbi made these comments in an interview.