Selatogrel provides heart attack patients with a lightning-fast antiplatelet response

A single dose of selatogrel can safely provide heart attack patients with a “profound, rapid” antiplatelet response, according to a new study published in the Journal of the American College of Cardiology.

There are multiple P2Y12 receptor antagonists currently available, the authors explained, but the antiplatelet effect often takes too long to occur, likely due to delayed absorption. This has created “an unmet need” for a P2Y12 receptor antagonist that acts quickly and can be easily administered. Could selatogrel fill that need?

“Selatogrel (ACT-246475), a highly selective and potent 2-phenylpyrimidine-4-carboxamide analog, represents a novel class of reversibly binding P2Y12 receptor antagonist,” wrote first author Peter Sinnaeve, MD, PhD, University Hospitals Leuven in Belgium, and colleagues. “Due to its particularly favorable pharmacokinetic and pharmacodynamic properties when administered subcutaneously, including a very rapid onset of action, selatogrel is being developed to provide an immediate treatment opportunity in patients with acute myocardial infarction (AMI) in the form of an injector for self-administration.”

The authors explored selatogrel’s effectiveness by administering a single subcutaneous dose to 47 male and post-menopausal female patients presenting with type 1 AMI. The median age was 69 years old, 72% of patients were male and 92% were white.

While 24 patients received a dose of 8 mg, the other 23 patients received a dose of 16 mg. From the group that received 8 mg, 91% experienced a response within 30 minutes; that number was 96% for the group that received 16 mg. There were no major bleeding complications.

“The extent of platelet inhibition during the first hour after selatogrel administration was much more profound than that observed shortly after either ticagrelor or prasugrel in previous ACS studies and seems to be largely similar to levels observed in healthy volunteers,” the authors wrote. “Importantly, the pronounced antiplatelet response was not associated with major bleeding complications in either dose group, despite most patients receiving concomitant anticoagulant therapies as standard of care."

The results of this research, the authors concluded, “warrant further studies to explore the clinical benefit and safety of a very early and pronounced platelet inhibition in the setting of AMI.”