ASH Clinical News December 2015 | Page 93

XARELTO® (rivaroxaban) tablets Table 3: Bleeding Events* in EINSTEIN Extension Study XARELTO† 20 mg N = 598 n (%) Placebo† 4 (0.7) 0 Decrease in Hb ≥2 g/dL 4 (0.7) 0 Transfusion of ≥2 units of whole blood or packed red blood cells 2 (0.3) 0 Gastrointestinal 3 (0.5) 0 Menorrhagia 1 (0.2) 0 Parameter Major bleeding event‡ Clinically relevant non-major bleeding Any bleeding N = 590 n (%) 32 (5.4) 7 (1.2) 104 (17.4) 63 (10.7) * Bleeding event occurred after the first dose and up to 2 days after the last dose of study drug. Although a patient may have had 2 or more events, the patient is counted only once in a category. † Treatment schedule: XARELTO 20 mg once daily; matched placebo once daily ‡ There were no fatal or critical organ bleeding events. Prophylaxis of Deep Vein Thrombosis Following Hip or Knee Replacement Surgery: In the RECORD clinical trials, the overall incidence rate of adverse reactions leading to permanent treatment discontinuation was 3.7% with XARELTO. The rates of major bleeding events and any bleeding events observed in patients in the RECORD clinical trials are shown in Table 4. Table 4: Bleeding Events* in Patients Undergoing Hip or Knee Replacement Surgeries (RECORD 1-3) XARELTO 10 mg Enoxaparin† Total treated patients N = 4487 N = 4524 n (%) n (%) Major bleeding event Fatal bleeding Bleeding into a critical organ Bleeding that required re-operation Extra-surgical site bleeding requiring transfusion of >2 units of whole blood or packed cells Any bleeding event‡ Hip Surgery Studies Major bleeding event Fatal bleeding Bleeding into a critical organ Bleeding that required re-operation Extra-surgical site bleeding requiring transfusion of >2 units of whole blood or packed cells Any bleeding event‡ Knee Surgery Study 14 (0.3) 1 (<0.1) 2 (<0.1) 7 (0.2) 4 (0.1) 9 (0.2) 0 3 (0.1) 5 (0.1) 1 (<0.1) 261 (5.8) N = 3281 n (%) 7 (0.2) 1 (<0.1) 1 (<0.1) 2 (0.1) 3 (0.1) 251 (5.6) N = 3298 n (%) 3 (0.1) 0 1 (<0.1) 1 (<0.1) 1 (<0.1) 201 (6.1) N = 1206 n (%) 7 (0.6) 0 1 (0.1) 5 (0.4) 1 (0.1) 191 (5.8) N = 1226 n (%) 6 (0.5) 0 2 (0.2) 4 (0.3) 0 Major bleeding event Fatal bleeding Bleeding into a critical organ Bleeding that required re-operation Extra-surgical site bleeding requiring transfusion of >2 units of whole blood or packed cells 60 (5.0) 60 (4.9) Any bleeding event‡ * Bleeding events occurring any time following the first dose of doubleblind study medication (which may have been prior to administration of active drug) until two days after the last dose of double-blind study medication. Patients may have more than one event. † Includes the placebo-controlled period for RECORD 2, enoxaparin dosing was 40 mg once daily (RECORD 1-3) ‡ Includes major bleeding events Following XARELTO treatment, the majority of major bleeding complications (≥60%) occurred during the first week after surgery. Other Adverse Reactions: Non-hemorrhagic adverse reactions reported in ≥1% of XARELTO-treated patients in the EINSTEIN Extension study are shown in Table 5. Table 5: Other Adverse Reactions* Reported by ≥1% of XARELTOTreated Patients in EINSTEIN Extension Study System Organ Class Preferred Term Gastrointestinal disorders Abdominal pain upper Dyspepsia Toothache General disorders and administration site conditions Fatigue Infections and infestations Sinusitis Urinary tract infection Musculoskeletal and connective tissue disorders Back pain Osteoarthritis Respiratory, thoracic and mediastinal disorders Oropharyngeal pain XARELTO N = 598 n (%) Placebo N = 590 n (%) 10 (1.7) 8 (1.3) 6 (1.0) 1 (0.2) 4 (0.7) 0 6 (1.0) 3 (0.5) 7 (1.2) 7 (1.2) 3 (0.5) 3 (0.5) 22 (3.7) 10 (1.7) 7 (1.2) 5 (0.8) 6 (1.0) 2 (0.3) * Adverse reaction (with Relative Risk >1.5 for XARELTO versus placebo) occurred after the first dose and up to 2 days after the last dose of study drug. Incidences are based on the number of patients, not the numb \