CHARISMA revisited: is the glass half full or just empty?

International Journal of Stroke : Official Journal of the International Stroke Society
Mark J Alberts

Abstract

The landmark CHARISMA study attempted to show that combination therapy with aspirin plus clopidogrel was superior to aspirin alone in a mixed population of patients with known vascular disease or those with risk factors for vascular disease. Although the study was negative for the combined group, a re-analysis of the outcomes and event rates showed striking differences between the two major patient types. Whereas individuals with risk factors only did not benefit from combination therapy, those with symptomatic vascular disease had a statistically significant 12% relative risk reduction in stroke/MI/vascular death with combination therapy vs aspirin alone. This dichotomous result was due largely to different event rates for the aspirin monotherapy group, being much higher in the symptomatic population compared to the risk factor group. Severe bleeding was not increased significantly for the symptomatic patients taking combination therapy vs aspirin alone. Based on these analyses, it may be premature to abandon combination therapy in a high-risk symptomatic population, especially since aspirin alone appears to have a high failure rate.

References

Jan 10, 1994·Archives of Internal Medicine·C H HennekensJ E Buring
Apr 3, 1999·JAMA : the Journal of the American Medical Association·P B GorelickD C Rhew
Aug 25, 2001·The New England Journal of Medicine·S YusufUNKNOWN Clopidogrel in Unstable Angina to Prevent Recurrent Events Trial Investigators
Nov 3, 2001·Stroke; a Journal of Cerebral Circulation·A J GrauH C Diener
Sep 18, 2002·JAMA : the Journal of the American Medical Association·Sharon E StrausFinlay A McAlister
Sep 18, 2002·JAMA : the Journal of the American Medical Association·Sharon E StrausFinlay A McAlister
Mar 9, 2005·The New England Journal of Medicine·Paul M RidkerJulie E Buring
Mar 11, 2005·The New England Journal of Medicine·Marc S SabatineUNKNOWN CLARITY-TIMI 28 Investigators
Nov 8, 2005·Lancet·Z M ChenUNKNOWN COMMIT (ClOpidogrel and Metoprolol in Myocardial Infarction Trial) collaborative group
Nov 8, 2005·The American Journal of Medicine·Nicolas RodondiUNKNOWN Health, Aging, and Body Composition Study research group
Jan 19, 2006·JAMA : the Journal of the American Medical Association·Jeffrey S BergerDavid L Brown
Mar 15, 2006·The New England Journal of Medicine·Deepak L BhattUNKNOWN CHARISMA Investigators
May 15, 2007·Journal of the American College of Cardiology·Deepak L BhattUNKNOWN CHARISMA Investigators

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Citations

Dec 11, 2014·Cancer Cell International·Carlos SonnenscheinAna M Soto
May 1, 2015·Journal of Helminthology·A N I PerumalR S Dassanayake

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CHARISMA

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