Oral Factor XIa Inhibitor Disappoints for Secondary Stroke Prevention

30 Dec 2023 • Factor XIa inhibition with milvexian, an investigational, oral factor XIa (FXIa) inhibitor, added to dual antiplatelet therapy, did not substantially reduce the composite outcome of symptomatic ischaemic stroke or covert brain infarction, the phase II trial AXIOMATIC-SSP found.

Milvexian is an oral inhibitor of activated factor XIa and is rapidly absorbed after oral administration, with a half-life of approximately 12 hours. The hope is that it would carry a lower risk of complications compared with available anticoagulants.

Previous phase II trials had supported milvexian as an effective anticoagulant with a good safety profile. However, in AXIOMATIC-SSP, the highest dose of milvexian was associated with renal adverse events and subsequent study discontinuation.

Milvexian is now under investigation in the phase III LIBREXIA-STROKE trial that is testing the 25-mg twice-daily dose against placebo in a targeted population of 15,000 stroke or TIA patients.

Source: The Lancet | Read full story

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