Eptifibatide (Integrilin, Millennium Pharmaceuticals) as an adjunct to PCI in STEMI patients is equally as effective as an adjunct therapy of abciximab (ReoPro, Eli Lilly/Centocor), according to the results of the EVA-AMI trial published in the Aug. 3 edition of the Journal of the American College of Cardiology.
Uwe Zeymer, MD, of the Institut für Herzinfarktforschung Ludwigshafen in Ludwigshafen, Germany, and colleagues sought to compare the effects of eptifibatide and abciximab as an adjunct to PCI in 427 patients who presented with STEMI.
Zeymer et al randomized patients into two groups: 226 were treated with a 10-minute interval, 180 ug/kg double bolus of eptifibatide followed by an infusion of 2 ug/kg/minute during a 24-hour period, and 201 were administered a 0.25 mg/kg bolus of abciximab followed by an infusion of 0.125 ug/kg/min during a 12-hour span.
The EVA-AMI (Eptifibatide Versus Abciximab in Primary PCI for Acute Myocardial Infarction) trial took place between November 2006 and May 2007, and enrolled STEMI patients who had planned PCI at 22 centers (11 in France and 11 in Germany). The primary endpoint used was the incidence rate of STEMI measured by complete ST-segment resolution (STR).
Results showed that the time between the onset of symptoms and the study medications was 3.9 hours in the eptifibatide group and 3.8 hours in the abciximab group. Additionally, the interval between the EKG and administration of the study drug was 54 minutes for the eptifibatide arm and 57 minutes for the abciximab arm. Intervals between the start of the drug and angiography were 28 minutes for eptifibatide and 30 minutes for abciximab.
The researchers initiated clopidogrel (Plavix, Bristol-Myers Squibb/Sanofi-Aventis) in 52 percent of patients 30 minutes prior to angiography, 30 minutes to one minute prior to angiography in 7 percent of patients and subsequent to angiography in 20 percent of patients—timing was unknown for 21 percent of the cases.
Zeymer et al identified 381 patients who were eligible to undergo PCI and electrocardiogram for the evaluation of STR. The incidence of complete STR was similar in the two groups—62.6 percent for eptifibatide and 56.3 percent for those treated with abciximab.
The researchers also found that 62.8 percent of patients in the eptifibatide arm and 58.6 percent in the abciximab arm reached the primary endpoint of completing STR at 60 minutes after PCI.
“In contrast to abciximab, eptifibatide induces a competitive and rapidly reversible antagonism, which might be desirable in patients with bleeding events or the need for urgent CABG,” the authors wrote. “However, the effect of abciximab can be readily reversed by platelet transfusion, which might not have the same efficacy in patients treated with small molecules.”
While the study’s intent was not to evaluate rates of mortality, nonfatal reinfarction and target vessel revascularization, the researchers found similar rates for both groups after six months.
Eptifibatide also had lower rates of reinfarctions, but had a higher incidence rate of major bleeds. Additionally, the authors said that eptifibatide may be less expensive than abciximab and induces a reversible receptor occupation.
“Our results suggest that eptifibatide as an adjunct to primary PCI in STEMI is equally effective to abciximab with respect to complete STR, a measure of myocardial reperfusion,” the authors concluded.