Eptifibatide use to increase

Two new studies presented during the American Hospital Association Scientific Sessions, Nov. 3-7, 2007, in Orlando, could speed the replacement of abciximab by eptifibatide in cardiac patients. EVA-AMI showed similar outcomes between the two drugs when used in percutaneous coronary intervention (PCI) and BRIEF-PCI showed that a two-hour infusion of eptifibatide can be as effective as the standard 18-hour course following uncomplicated PCI procedures.

EVA-AMI randomized 400 patients with STEMI scheduled for primary PCI, explained Uwe Zeymer, MD, Herzzentrum Ludwigshafen, Ludwigshafen, Germany. One-half of the patients got eptifibatide before PCI and one-half received abciximab. The primary endpoint was complete ST resolution within one hour following PCI. Secondary endpoints included death, reinfarction, target vessel revascularization, stroke, and bleeding 30 days post-PCI.

"There was no statistical difference between the two agents for these endpoints," Dr Zeymer said. "And eptifibatide is less expensive."

Much less expensive. Abciximab costs $1700 per patient versus $400 for eptifibatide, said Anthony Fung, MD, division of cardiology, Vancouver General Hospital, University of British Columbia, Canada. The price gap stretches even wider for patients with an uncomplicated PCI. BRIEF-PCI data shows that the standard 18-hour eptifibatide infusion can be cut to two hours with no change in efficacy.

The study compared 624 patients who underwent successful non-emergent uncomplicated PCI with stenting. Patients were randomized to receive standard eptifibatide therapy, a double bolus followed by an 18-hour infusion, or the same double bolus followed by a two-hour infusion.

There was no difference in peri-procedural ischemic myocardial injury between the two groups, Dr Fung reported, and less bleeding in the two-hour group.

"We believe that eptifibatide infusion can safely be reduced to two hours In this select population," Dr Fung said. "That change in treatment reduces drug costs to 37% of the standard regimen and significantly reduces length of stay and associated costs. The lower incidence of bleeding should reduce overall nursing time."

Vancouver General has been using the two-hour infusion regimen for some time based on observational data, Dr Fung said.

"Now we have randomized controlled trial results to support what we have seen works in practice. I would not be surprised to see similar changes elsewhere now that the data are out there."