Ticagrelor reduced risk of infection compared with clopidogrel: a meta-analysis

Abstract

Introduction: Ticagrelor has antibacterial activity in vitro.1 In the PLATO (Platelet Inhibition and Patient Outcomes) trial, ticagrelor reduced the incidence of pneumonia and improved lung function. We conducted a meta-analysis to investigate if ticagrelor reduces the risk of infections. Methods: We searched Medline, Embase, Cochrane Library, and clinicaltrials.gov for randomised controlled trials comparing ticagrelor and clopidogrel that have reported the incidence of infection. The primary outcome was pneumonia. Secondary outcomes were upper respiratory tract infection (URTI), urinary tract infection (UTI), and sepsis. Odds ratios (ORs) and 95% confidence intervals (CIs) were combined with random-effects model in RevMan version 5.3. Results: Out of 5231 citations, 13 trials with altogether 90 679 patients were included. Ticagrelor was associated with a lower risk of pneumonia (OR=0.79, 95% CI=0.66-0.95) compared with clopidogrel, but no statistically significant difference was observed for URTI (OR=0.68, 95% CI=0.33-1.43), UTI (OR=1.06, 95% CI=0.75-1.49), or sepsis (OR=0.79, 95% CI=0.52-1.21). Conclusion: Our meta-analysis provides further evidence that ticagrelor reduces the risk of pneumonia, when compared with clopidogrel. Our results did not show a reduction in URTI, UTI, or sepsis. Further research is needed to investigate the effect of ticagrelor on infections. Reference: 1. Lancellotti P, Musumeci L, Jacques N, et al. Antibacterial activity of ticagrelor in conventional antiplatelet dosages against antibiotic-resistant Gram-positive bacteria. JAMA Cardiol 2019;4:596-9.