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2024-08-26T12:42:06.000Z

Twice-daily vs once-daily low-dose aspirin for ET: Results from the ARES trial

Aug 26, 2024
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Learning objective: After reading this article, learners will be able to cite a new clinical development in essential thrombocythemia.

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The phase II ARES trial (EudraCT 2016–002885-30) assessed the long-term pharmacodynamic superiority and safety of a twice-daily 100 mg aspirin regimen vs the standard once-daily regimen in 242 adult patients with essential thrombocythemia (ET).1 Results from this trial were published in the American Journal of Hematology by Rocca et al.1

Key learnings1
The primary endpoint was met; during a 20-month follow-up, patients who were treated with the twice-daily low-dose aspirin regimen showed significantly lower levels of serum thromboxane B2 compared with once-daily dosing (median, 3.9 vs 19.2 ng/ml; p < 0.001), suggesting enhanced antithrombotic efficacy.
Twice-daily low-dose aspirin dosing was associated with a reduction in disease-specific symptoms vs standard once-daily dosing (no reported symptoms, 17.3% vs 14.3%; p < 0.05; ≥8 reported symptoms; 7.9% vs 13.0%; p = 0.0001) and significant relief from severe hand and foot microvascular pain, without an increase in upper gastrointestinal discomfort.
Bleeding risks were similar between the twice-daily and once-daily aspirin regimens, although there was a trend towards more clinically relevant non-major bleeding in the twice-daily group (8 vs 2).
This study supports consideration of twice-daily low-dose aspirin as a well-tolerated and potentially more effective option for managing patients with ET, particularly in those with high symptom burden and risk of thrombotic events.

  1. Rocca B, Tosetto A, Petrucci G, et al. Long-term pharmacodynamic and clinical effects of twice- versus once-daily low-dose aspirin in essential thrombocythemia: The ARES trial. Am J Hematol. 2024;99(8):1462-1474. DOI: 1002/ajh.27418

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