Etripamil Nasal Spray for Rapid Conversion of Supraventricular Tachycardia to Sinus Rhythm
Bruce S Stambler, Paul Dorian, Philip T Sager, Douglas Wight, Philippe Douville, Diane Potvin, Pirouz Shamszad, Ronald J Haberman, Richard S Kuk, Dhanunjaya R Lakkireddy, Jose M Teixeira, Kenneth C Bilchick, Roger S Damle, Robert C Bernstein, Wilson W Lam, Gearoid O'Neill, Peter A Noseworthy, Kalpathi L Venkatachalam, Benoit Coutu, Blandine Mondésert, Francis Plat, Bruce S Stambler, Paul Dorian, Philip T Sager, Douglas Wight, Philippe Douville, Diane Potvin, Pirouz Shamszad, Ronald J Haberman, Richard S Kuk, Dhanunjaya R Lakkireddy, Jose M Teixeira, Kenneth C Bilchick, Roger S Damle, Robert C Bernstein, Wilson W Lam, Gearoid O'Neill, Peter A Noseworthy, Kalpathi L Venkatachalam, Benoit Coutu, Blandine Mondésert, Francis Plat
Abstract
Background: There is no nonparenteral medication for the rapid termination of paroxysmal supraventricular tachycardia.
Objectives: The purpose of this study was to assess the efficacy and safety of etripamil nasal spray, a short-acting calcium-channel blocker, for the rapid termination of paroxysmal supraventricular tachycardia (SVT).
Methods: This phase 2 study was performed during electrophysiological testing in patients with previously documented SVT who were induced into SVT prior to undergoing a catheter ablation. Patients in sustained SVT for 5 min received either placebo or 1 of 4 doses of active compound. The primary endpoint was the SVT conversion rate within 15 min of study drug administration. Secondary endpoints included time to conversion and adverse events.
Results: One hundred four patients were dosed. Conversion rates from SVT to sinus rhythm were between 65% and 95% in the etripamil nasal spray groups and 35% in the placebo group; the differences were statistically significant (Pearson chi-square test) in the 3 highest active compound dose groups versus placebo. In patients who converted, the median time to conversion with etripamil was <3 min. Adverse events were mostly related to the intranasal route of administration or local irritation. Reductions in blood pressure occurred predominantly in the highest etripamil dose.
Conclusions: Etripamil nasal spray rapidly terminated induced SVT with a high conversion rate. The safety and efficacy results of this study provide guidance for etripamil dose selection for future studies involving self-administration of this new intranasal calcium-channel blocker in a real-world setting for the termination of SVT. (Efficacy and Safety of Intranasal MSP-2017 [Etripamil] for the Conversion of PSVT to Sinus Rhythm [NODE-1]; NCT02296190).
Keywords: atrioventricular nodal re-entrant tachycardia; atrioventricular reciprocating tachycardia; calcium-channel blocker; conversion rate; episodic treatment; paroxysmal supraventricular tachycardia.
Copyright © 2018 Milestone Pharmaceuticals Inc. Published by Elsevier Inc. All rights reserved.
Source: PubMed