Keith Dawkins MD FRCP FACC FSCAI Keith Dawkins MD FRCP FACC FSCAI Chief Medical Officer Chief Medical Officer Senior Vice President Senior Vice President Boston Scientific Corporation Boston Scientific Corporation Why Boston Scientific Persists with the Two-Drug Strategy London - January 2010 London - January 2010
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Keith Dawkins MD FRCP FACC FSCAI Chief Medical Officer Senior Vice President
Why Boston Scientific Persists with the Two-Drug Strategy. Keith Dawkins MD FRCP FACC FSCAI Chief Medical Officer Senior Vice President Boston Scientific Corporation. London - January 2010. Conflicts of Interest. Employee Boston Scientific Corporation Stockholder - PowerPoint PPT Presentation
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Keith Dawkins MD FRCP FACC FSCAIKeith Dawkins MD FRCP FACC FSCAIChief Medical OfficerChief Medical OfficerSenior Vice PresidentSenior Vice PresidentBoston Scientific CorporationBoston Scientific Corporation
Why Boston Scientific Persists with the Two-Drug Strategy
London - January 2010London - January 2010
Conflicts of InterestConflicts of Interest
EmployeeBoston Scientific Corporation
StockholderBoston Scientific Corporation
Boston Scientific Two-Drug StrategyBoston Scientific Two-Drug StrategyTAXUS LibertTAXUS Libertéé PROMUSPROMUS
Why do Interventional Cardiologists Why do Interventional Cardiologists use a particular Stent?use a particular Stent?
SalesSales
MarketingMarketing
PerformancePerformanceDataData
CostCost
SafetySafety
HospitalityHospitality
CompetitionCompetitionCompetitionCompetition
HospitalityHospitality
HospitalHospitalAdministratorAdministrator
6 Platforms
18 Pre-Market and 11 Post-Market studies
9,138 IDE Patients with 90,560 Patient-Years of F/U
37,498 PMS Patients with 52,680 Patient-Years of F/U
46,636 TAXUS patients with 143,240 Patient-Years of F/U
Prevalence of Diabetes MellitusPrevalence of Diabetes Mellitus
Which DES for the Diabetic Patient?
Targ
et L
esio
n Fa
ilure
(%)
TLF=Cardiac Death, Target Vessel MI, or ischemia driven TLF=Cardiac Death, Target Vessel MI, or ischemia driven TLRTLR1 year = 365 ± 28 days 1 year = 365 ± 28 days
TLF=Cardiac Death, Target Vessel MI, or ischemia driven TLF=Cardiac Death, Target Vessel MI, or ischemia driven TLRTLR1 year = 365 ± 28 days 1 year = 365 ± 28 days
Targ
et L
esio
n Fa
ilure
(%)
33/562 16/199
SPIRIT IV: SPIRIT IV: Impact of Diabetes Type (TLF 1-yr)Impact of Diabetes Type (TLF 1-yr)
TLF=Cardiac Death, Target Vessel MI, or ischemia driven TLF=Cardiac Death, Target Vessel MI, or ischemia driven TLRTLR1 year = 365 ± 28 days 1 year = 365 ± 28 days
Diabetic Restenosis: Diabetic Restenosis: the MAPK Pathwaythe MAPK Pathway
**Medically Treated DiabetesMedically Treated Diabetes Published Data up to 01.2010Published Data up to 01.201011% Relative Increase in TLR for Patients with Diabetes11% Relative Increase in TLR for Patients with Diabetes
StudyStudy DMDMOddsOddsRatioRatio
UpperUpperLimitLimit
LowerLowerLimitLimit
RelativeRelativeWeightWeight Odds Ratio and 95% CIOdds Ratio and 95% CI
Next Generation DESNext Generation DESLow Drug Dose, Ablumenal Delivery, Bioerodable Low Drug Dose, Ablumenal Delivery, Bioerodable
Polymer Short DAPTPolymer Short DAPT??
Trial to commenceQ2 2010
Conclusions:Conclusions:Nine years of clinical data attest to the safety and efficacy of TAXUS stents. Differences in outcome between Diabetic and Non-Diabetic patients based on the MOA is real, favouring Paclitaxel as the drug of choice.Late Loss drift associated with –olimus eluting stents remains an unresolved issue of possible clinical significance.The Two-Drug strategy affords dominant market share.BSC continues to assess the roles of a Two-Drug strategy in the DES pipeline.