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Eptifibatide Is Noninferior to Abciximab: Implications for Clinical Practice

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Eptifibatide Is Noninferior to Abciximab: Implications for Clinical Practice RESEARCH HIGHLIGHTS ANTIPLATELET THERAPY Eptifibatide is noninferior to abciximab: implications for clinical practice he glycoprotein IIb/IIIa (GPIIb/ randomized, open, parallel-group January 2004 and December 2007, IIIa) inhibitors eptifibatide and comparison of eptifibatide and abciximab and eptifibatide was used in 2,355 Tabciximab have comparable efficacy in 427 patients presenting within 12 h such procedures over this time frame. and safety in patients with ST-segment of STEMI onset and who underwent During the 1-year follow-up period, elevation myocardial infarction (STEMI) primary PCI. Enrolled patients were from no significant difference was reported undergoing primary percutaneous 22 centers in France and Germany. The for the incidence of death (8.0% and coronary intervention (PCI). These two study drugs were administered in 7.6%), myocardial infarction (9.0% and findings, from a randomized trial and a combination with background therapy 8.4%), or bleeding (2.7% and 3.2%) registry study, are reported in two papers comprising clopidogrel, aspirin, and between abciximab and eptifibatide, published in the Journal of the American heparin or enoxaparin. This study used respectively. Multivariable analysis College of Cardiology (JACC). the surrogate primary end point of showed that eptifibatide was noninferior Platelet aggregation and thrombus complete electrocardiographic ST-segment to abciximab for the prevention of death formation can be inhibited by blocking resolution (STR) 60 min after completion or myocardial infarction (odds ratio 0.94, the GPIIb/IIIa receptor on the platelet of PCI. 95% CI 0.82–1.09). membrane, thereby preventing the binding In the intention-to-treat analysis, These findings “fuel an already much of fibrinogen. Platelet inhibition has been no significant difference between the debated hypothesis that high-dose GPIIb/ shown to reduce the risk of cardiovascular treatment groups was found in the IIIa inhibitors, although very different events in patients with acute coronary percentage of patients who achieved in terms of action, reversibility, and cost, syndromes who are undergoing PCI. complete STR (eptifibatide 62.6% versus provide adequate and comparable platelet Several GPIIb/IIIa inhibitors are available abciximab 56.3%; adjusted difference 7.1%; inhibition and that the clinical use of either as adjuncts to PCI; abciximab is the most 95% CI 2.7–17.0%). Although the trial drug is feasible,” concludes Dr Åkerblom. studied and is recommended for use in was not powered to assess hard clinical Commenting on these two studies, with this setting by the European Society of outcomes, the reported incidence of death, which he was not involved, A. Michael Cardiology and the American College stroke, revascularization, and bleeding Lincoff from the Cleveland Clinic, OH, of Cardiology/American Heart Association 30 days after PCI was not significantly USA cautions that “the results are plausible, guidelines. Although eptifibatide is different between the two groups. “This but not definitive”. He goes on to reveal that approved and widely used, it is not was the first randomized trial comparing “the field is [however] moving away from currently recommended by the guidelines, gold-standard abciximab with eptifibatide,” this entire class of platelet inhibitors.” In owing to relative lack of data for this agent says Dr Zeymer. “Our findings suggest the HORIZONS trial, the direct thrombin in comparison with abciximab. The two equal efficacy and safety [of these inhibitor bivalirudin was associated with studies published in JACC are, therefore, two drugs] and support reports from reduced bleeding and 1-year mortality important additions to the literature. nonrandomized retrospective studies.” when compared with abciximab. “Thus, The EVA-AMI trial, reported by Uwe The second study was reported by comparisons between different GPIIb/ Zeymer and colleagues, was a prospective, researchers from Sweden. Axel Åkerblom IIIa antagonists ... are of diminishing and co-workers retrospectively evaluated importance as many interventionalists data from the Swedish Coronary are substituting bivalirudin for GPIIb/IIIa Angiography and Angioplasty Registry [antagonists] entirely.” (SCAAR). In 2004, several hospitals in Alexandra King Sweden switched from using abciximab to eptifibatide, which is the less expensive of the two drugs. “This switch ... was Original articles Zeymer, U. et al. Randomized comparison very closely monitored via the SCAAR” of eptifibatide versus abciximab in primary percutaneous coronary intervention in patients with acute ST-segment explains Dr Åkerblom. “This registry can elevation myocardial infarction: results of the EVA-AMI Trial. be combined with the national registry J. Am. Coll. Cardiol. 56, 463–469 (2010) | Åkerblom, A. of health and long-term follow-up is et al. Eptifibatide is noninferior to abciximab in primary thereby gained.” percutaneous coronary intervention: results from the SCAAR (Swedish Coronary Angiography and Angioplasty ebastian Kaulitzki | Dreamstime.com S Abciximab was used in 9,124 primary Registry). J. Am. Coll. Cardiol. 56, 470–475 (2010) © PCIs for patients with STEMI between NATURE REVIEWS | CARDIOLOGY VOLUME 7 | OCTOBER 2010 | 539 © 2010 Macmillan Publishers Limited. All rights reserved.
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