To the extent people assumed KCentra to be more effective than this (like UpToDate guidelines), the PR is good news. I always assumed KCentra did virtually nothing vs FXa inhibitors, so this isn't necessarily good news to me.
i.e. When life-threatening and high FXa inhibition levels, Andexxa is a lock. What's needed is more and more expansion into less than absolute life-threatening situations. But from this PR, we now know maybe 25% of the "potential Andexxa patients" have levels < 75 ng/ml, and might be effectively treated with KCentra. That's a big chunk. And I wonder what the FXa inhibition curve looks like at the tail end. How quickly does it drop off from that reported median level of 94 ng/ml to a potential KCentra level below 75 ng/ml? If only a few hours, then it could chip away even further.
Other potential factors???
- Maybe with NTP payments, the cost delta isn't a big enough to worry about? I doubt this because many cases need more than a single dose, so the cost delta is not what I'd call small.
- If prepping Andexxa is a PITA and takes time anyway, you might just have more people sticking with KCentra as first-line, and Andexxa second line therapy. Say you would've had to wait an hour for A prep, so you decide to just wait a couple hours for 75 ng/ml, then use KCentra. Again, we're talking outside of life-threatening bleeds, high concentrations, etc).
"For example, in the ANNEXA-4 trial of Andexxa in Factor Xa inhibitor-treated patients with acute major bleeding, approximately 75% of the patients had anticoagulant concentrations above 75 ng/mL at the time of Andexxa reversal therapy."