Microsoft word - desknote_cie_-_sanofi-aventis_-_419242_fr_l.doc
Reco. confirmée Mortalité globalement similaire entre prasugrel et Plavix, en raison de saignements fatals
Q Actualité Les résultats de lessai clinique de grande envergure de phase 3 (TRITON-TIMI 38)
sur prasugrel, concurrent du Plavix développé par Eli Lilly/Sankyo, ont été présentés hier à
loccasion du congrès de lAmerican Heart Association. Lilly a par ailleurs organisé le 4/11 une
conférence téléphonique. Nous anticipions une efficacité supérieure avec toutefois des
saignements similaires, la véritable problématique reposant toutefois sur la pertinence clinique
de ces résultats dans la mesure où la charge de Plavix utilisée était de moitié inférieure à celle
utilisée maintenant couramment. Le profil deffets secondaires du prasugrel apparaît moins bon
que prévu, limitant la menace à court terme quil pourrait représenter sil devait obtenir son
autorisation de mise sur le marché (ce qui reste à voir). Dans cet essai de grande échelle mené
sur 13 608 patients, lefficacité du prasugrel administré en plus dune faible dose daspirine
sest révélée supérieure à celle du clopidogrel (Plavix), administré également en plus dune
faible dose daspirine, pour réduire les risques daccidents cardio-vasculaires graves chez les
patients souffrant dune insuffisance coronarienne aiguë et subissant une intervention
coronarienne percutanée. Notons toutefois que les saignements fatals provoqués par le
traitement étaient 4 fois supérieurs avec prasugrel (comparé au Plavix). Globalement, le taux de
mortalité na pas varié entre les deux groupes. Selon nous, Lilly/Sankyo devra sensiblement
augmenter le nombre dessais cliniques à grande échelle sil souhaite que prasugrel devienne
Q Impact Les résultats concernant Prasugrel démontrent la difficulté de trouver un produit plus
efficace que Plavix mais ne présentant pas deffets secondaires (saignements) plus néfastes.
Lilly/Sankyo devrait déposer sa demande denregistrement auprès de la FDA avant fin 2007.
Reste à savoir si la FDA approuvera prasugrel sur la base de ces données avant fin 2009.
Q Objectif de cours & recommandation Recommandation Achat maintenue avec un objectif
de cours de 77 . Le cours du titre Sanofi-Aventis na pas réagi après lissue positive
concernant le brevet de Plavix aux Etats-Unis alors que les investisseurs étaient encore
sous le choc de la récente décision négative du Comité consultatif de la FDA sur Acomplia
et anticipaient lavènement inéluctable de la concurrence avec prasugrel. La voie est
Q Prochains évènements & catalyseurs 10 décembre : présentation des résultats létude de
phase IIb TREK avec AVE5026, un anti-coagulant qui pourrait potentiellement remplacer
Lovenox. Les données partielles communiquées lors de la journée R&D du 17/09 ont montré
une efficacité supérieure par rapport au Lovenox ainsi quun meilleur profil deffets secondaires
SG a été seul teneur de livre associé de l'émission de titres obligataires senior (FRN 01/12/2008 EUR) par Sanofi-Aventis La Société Générale et ses filiales détiennent une participation de 1% ou plus dans Sanofi-Aventis.
PLEASE SEE IMPORTANT DISCLAIMER AND DISCLOSURES ON LAST PAGE
Sanofi-Aventis
Additional information (SANOFI-AVENTIS) The major results are summarised in the two tables below, the first one on efficacy end-points,
the second one on the bleeding end-points, as published in the New England Journal of
Source: Wiviott SD, Braunwald E, McCabe CH, et al. N Eng J Med 2007; 357:2001-2015
Source: Wiviott SD, Braunwald E, McCabe CH, et al. N Eng J Med 2007; 357:2001-2015; (a) key safety end-point; (b) Relates to the number of patients who underwent CABG (179 in the prasugrel group and 189 in the clopidogrel group)
Données normalisées Marge d'EBITDA (%)
Overall, no difference in mortality when all events are considered
Overall, for every 1000 patients treated with prasugrel as compared with clopidogrel, 23
Myocardal Infarcts (MI) were prevented, with an excess of six non-CABG-related TIMI major
Recherche crédit* STABLE. Actuellement, le principal moteur
hemorrhages. The investigators of TRITON-TIMI 38 themselves conclude in their article
de crédit de Sanofi est l'OPA potentielle sur
Bristol-Myers Squibb, et la façon dont elle
published today in the NEJM that when considering the choice of antiplatelet regimens for
différentes combinaisons de financement
the treatment of patients with ACS who are undergoing PCI, clinicians need to weigh the
dette/actions, à 75%, 50% et 25%, le levier
financier de l'entité combinée pourrait se
benefits and risks of intensive inhibition of platelet aggregation.
dégrader jusqu'au niveau de notation midà
low single-A ou rester en ligne avec les
The TRITONTIMI 38 study validates the hypothesis that greater degrees of adenosine
diphosphatemediated platelet inhibition (the mechanism of action by which ticlopidine,
Plavix ancestor, a Sanofi product and Plavix are working) are indeed associated with a
greater suppression of clinical ischemic events, but as noted in the Editorial of todays NEJM:
Thus, there is a price to pay for greater platelet inhibition and the accompanying reduction in
ischemic events: higher rates of serious bleeding. ( ) In TRITONTIMI 38, for each death from
cardiovascular causes prevented by the use of prasugrel as compared with clopidogrel,
approximately one additional episode of fatal bleeding was caused by prasugrel. ( )TRITON
TIMI 38 was a clinical trial, and as in all trials of antithrombotic therapy, patients perceived to
be at high risk for bleeding were excluded. Thus, in a “real-world” setting, such as in an elderly patient with multiple coexisting conditions, the risk of major bleeding and even fatal bleeding may be increased to an even greater degree than was seen in TRITON– TIMI 38. Sanofi-Aventis IMPORTANT DISCLAIMER: The information herein is not intended to be an offer to buy or sell, or a solicitation of an offer to buy or sell, any securities and including any expression of opinion, has been obtained from or is based upon sources believed to be reliable but is not guaranteed as to accuracy or completeness although Société Générale (SG) believe it to be clear, fair and not misleading. 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