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News

Boston Scientific reveal Taxus ATLAS clinical programme trial results

Boston Scientific : 13 October, 2008  (Company News)
Comprehensive data has been announced by Boston Scientific from the Taxus ATLAS clinical programme, a series of global, prospective, multi-centre, single-arm, historically controlled trials, which evaluated the Taxus Liberte Paclitaxel-Eluting Stent System in a variety of lesions and patient groups.
The Taxus Liberte Stent received US Food and Drug Administration approval last week. Results from the Taxus ATLAS Workhorse, Direct Stenting, Small Vessel and Long Lesion trials were presented at the Cardiovascular Research Foundation's (CRF) annual Transcatheter Cardiovascular Therapeutics (TCT) scientific symposium in Washington, DC, USA.

'The Taxus ATLAS studies reinforce the long-term safety and efficacy of the Taxus Liberte Stent while demonstrating the ability to access complex lesions. The data showed significantly reduced restenosis in small vessels and positive results in direct stenting procedures,' said Mark A Turco, MD, director of the Center for Cardiac and Vascular Research, Washington Adventist Hospital, and co-principal investigator of the trial. 'The positive ATLAS data suggest that improvements in Stent design and a reduction in strut thickness may contribute to improved clinical outcomes for patients treated with the Taxus Liberte Stent.'

Three-year data from the Taxus ATLAS Workhorse study were presented by Dr Turco. Taxus ATLAS Workhorse enrolled 871 patients at 61 sites, comparing patients with de novo coronary lesions treated with the Taxus Liberte Stent to a historical case-matched Taxus Express Stent control group.

In spite of more complex patients treated with the Taxus Liberte Stent, the adjusted data demonstrated that the safety and efficacy benefits of the Taxus Liberte Stent System were maintained at three years in workhorse lesions. The study reported similar rates of target lesion revascularization (TLR) of 9.3 percent for the Taxus Liberte Stent vs. 9.6 percent for the Taxus Express control Stent (p=0.81).

Three-year data also showed comparable rates of cardiac death (3.4 percent for the Taxus Liberte Stent vs. 2.3 percent for the Taxus Express Stent, p=0.20) and overall myocardial infarction (MI) (5.2 percent for the Taxus Liberte Stent vs. 6.3 percent for the Taxus Express Stent, p=0.36). The adjusted rate of ARC definite/probable Stent thrombosis at three years for the Taxus Liberte Stent group was 2.0 percent, as compared to 2.2 percent for the control group (p=0.76). Since the trial's primary end point was reported at nine months, the overall target vessel revascularization (TVR) rate through three years was significantly lower for the Taxus Liberte Stent group (6.1 percent versus 9.1 percent for control, p=0.0178), suggesting a late benefit of the thin-strut Taxus Liberte Stent.

Dr Turco also presented two-year data from the Taxus ATLAS Direct Stent clinical trial, a 247-patient study assessing the safety of direct stenting with the Taxus Liberte Stent compared to placement of a Taxus Liberte Stent using balloon pre-dilatation. The control arm for the trial is the angiographic cohort of the Taxus ATLAS Workhorse clinical trial, which mandated pre-dilatation. Although the ATLAS Workhorse and ATLAS Direct Stent trials had the same inclusion and exclusion criteria, simpler lesions were selected for the direct Stent group.

The study reported a low two-year adjusted overall MACE (major adverse cardiac events) rate of 11.2 percent for the direct Stent group, as compared to 19.1 percent for the pre-dilatation control group (p=0.0055). The difference was driven mainly by the 67 percent lower rate of target lesion revascularization (TLR) in the direct Stent group (3.0 percent versus 9.0 percent, p=0.0005). The additional components of MACE (cardiac death and overall MI) were low and comparable between the two groups. The study also reported a significantly lower adjusted rate of ARC definite/probable Stent thrombosis for the direct Stent group at 0.3 percent, as compared to 2.1 percent for the control group (p=0.0113).

'Overall, the trial suggests that using the direct stenting method with the Taxus Liberte Stent in carefully selected lesions can result in improved outcomes through two years compared with pre-dilatation,' said Dr Turco.

Two-year data from the Taxus ATLAS Small Vessel and Long Lesion studies were presented by John A Ormiston, MD, Green Lane and Mercy Hospital, Auckland, New Zealand and co-principal investigator of the trial. The Taxus ATLAS Small Vessel study is designed to evaluate the long-term safety and efficacy of the Taxus Liberte 2.25mm Stent compared to the highly effective first-generation Taxus Express 2.25mm Stent.

The Taxus Liberte 2.25 mm Stent showed a statistically significant reduction in target lesion revascularization (TLR) at two years with a rate of 8.2 percent as compared to 20.3 percent in the Taxus Express Stent (p=0.0046), resulting in a 60 percent relative reduction. Overall target vessel revascularization (TVR) was 12.8 percent for the Taxus Liberte Stent compared to 26.1 percent for the Taxus Express Stent (p=0.0072), a 51 percent reduction.

The two-year MACE rate for the Taxus Liberte 2.25mm Stent was 16.5 percent compared to 30.4 percent for the Taxus Express Stent (p=0.0098), a relative reduction of 46 percent. ARC definite/probable total Stent thrombosis at two years was 0.8 percent for the Taxus Liberte 2.25mm Stent compared to 1.5 percent for the Taxus Express Stent control group (p=0.52).

'The Taxus Liberte 2.25 mm Stent significantly reduced restenosis and maintained or improved safety outcomes in small vessels compared to the Taxus Express Stent,' said Dr Ormiston.

The Taxus ATLAS Long Lesion study is designed to assess the long-term safety and efficacy of the Taxus Liberte Long (38 mm) Stent compared with the Taxus Express Stent in patients with long lesions. Two-year data showed the Taxus Liberte Long Stent maintained safety and effectiveness results in treating long lesions. TLR was 9.1 percent for the Taxus Liberte Long Stent compared to 10.1 percent for the Taxus Express Stent (p=0.76). The composite measure of cardiac death or MI showed a significant 63 percent reduction in Taxus Liberte Long Stent patients compared to Taxus Express Stent patients (3.5 percent vs. 9.4 percent, p=0.0426).

All cause death was reported as 2.8 percent for the Taxus Liberte Long Stent and 4.3 percent for the Taxus Express Stent (p=0.53). The Taxus Liberte Long Stent showed no Stent thrombosis at two years using either the Protocol definition or the ARC definite/probable definition while the Taxus Express control Stent reported 0.8 percent (p=0.49) using the Protocol definition and 1.5 percent (p=0.24) using the ARC definition.

'The next-generation Taxus Liberte Stent, with its thinner struts and more uniform cell geometry, was able to reduce the risk of cardiac death or MI at two years for patients with long lesions in this study,' added Dr Ormiston.

The company received the CE Mark for the Taxus Liberte Stent in Europe and other international markets in September 2005, and received CE Mark for the Taxus Liberte Long Stent in May 2007. The company received US Food and Drug Administration approval for its Taxus Express2 Atom Paclitaxel-Eluting Coronary Stent System for use in vessels as small as 2.25mm in diameter and the Taxus Liberte Stent for coronary vessels 2.5 mm to 4.0 mm in diameter. The Taxus Liberte 2.25mm Stent and the Taxus Liberte Long Stent are currently pending approval by the US Food and Drug Administration and are limited by federal law to investigational use and not available for sale in the USA.
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