For anyone who is hesitant to take anticoagulants there may be hope on the horizon according to this article. A new type of anticoagulant has just come out of trials and seems to be hopeful in preventing thrombosis whilst reducing bleed risk:-
"It has been discovered that factor XI has a really unique position in the cascade of how our body forms clots in that it seems to be important in clot formation, but it doesn't seem to play a major role in our ability to heal and repair blood vessels."
It’s a long read but quite interesting but of course these new drugs will come at a cost and at a time when generic DOACs are becoming available so there will always be the more cynical that this is Big Pharma making unreasonable profit. Note the last few paras on the last page and page 3 which talks about the biggest target market being AF patients.
I tried researching on the internet but didn't find much understanding re the differences in potential "risks and problems" between this new "biological" and the current DOACs.
Could you indicate what are the concerns you had in mind when you mention "biologicals" in this context?
I am not wanting to scare Forum readers, but simply trying to better inform myself in this area, particularly as I have a history of acute intracranial bleeds and this potential new "drug" is of obvious interest to me.
Biological are monoclonal - any pharmaceutical with a suffix ‘mab’ indicates monoclonal antibodies which have been used for treating quite a few conditions in the last 10-15 years, mainly autoimmune such as MS, RA etc which is how I first came across them. They have also been used to fight pathogens, including COVID.
I don’t know enough about how this particular proposed drug works so all the info I have is from this article however suggest you google Understanding How Monoclonal Antibodies Work - NCBI Library of Medicine.
They were trialled in US but I don’t ever used in UK. I seem to remember that US Medical Chief Officer of the time hailing them as THE solution but that was really early days of the pandemic.
As I understand it, this excellent article is discussing 3 candidates-two "small molecule" candidates (names ending in -xian), and one biological, monoclonal antibody (name ending in the familiar -imab).
Assuming (big assumption) that all function equally well for thrombosis prevention, still there are important differences between the small molecules and the monoclonal antibody.
The monoclonal antibody is a long duration therapy, once a month by injection. While this sounds ideal from a compliance standpoint, it is not so ideal if "something goes wrong" - you're kind of stuck in a bad place!
More importantly, it has been shown that with the large molecule monoclonal antibodies, after time the body will begin to make antibodies AGAINST the foreign antibody, thus destroying any therapeutic benefit over time. Afib patients cannot afford these potential long gaps in coagulation prevention!
The small molecule candidates will undoubtedly have a faster onset of action and a much shorter duration of activity. While perhaps inconvenient from a compliance standpoint, much easier to control untoward events that should occur. Long term resistance DOES occur with SOME small molecule drugs, but to a lesser extent than with monoclonal antibodies. (that is a personal opinion), and it is much easier to change therapies with drugs of "short duration", avoiding a prolonged period of "flushing out" the existing drug.
Cost is also an important factor, and I challenge all to find me a monoclonal antibody therapy that does not cause extreme "sticker shock"!
The trouble with most drugs is they can cure one problem, but over time can have an effect on other parts of our bodies. That's the known thing that always concerns me with any new drug - what will the side effects be?
I have to be honest and say that's why I stay on Warfarin which has been used for around 60+ years and I know that people have lived long lives when taking it.
Yes, new drugs may turn out to be more efficient. I wont be one of the people that they're trialled on though. In the 1970's I took the drug Debendox for morning sickness. That was a little like a second thalidomide pill in that it was said to cause birth defects and withdrawn from use.
I wonder if the new drug talked about here and given monthly by injection will mean going to the doctors surgery one a month, or will people be able to give it to themselves. What would happen if you wanted to go travelling for a long period of time?
Sadly, these days I view most drugs with suspicion.
I think I mostly agree with you but this drug, if proved and is considered ‘safe’ will help a huge number of people who just cannot take anticoagulants currently on the market for a number of reasons and we both know a few of those.
Sounds a good breakthrough, but it would have to be prescribed, tried and tested for a good few years before l would even consider taking it. Unfortunately, over the years, and because of events in my life, l don’t fully trust the medical profession any more. There are side effects to all drugs and many cure one thing but give you another. We shall see …….. Thanks for keeping us informed. 😀
very interesting- thanks for the info - also had no idea that 1 in 3 people may/will develop AF in their lifetime - had never heard of it before it hit me - you’d think we would know things like this if so prevalent
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