The Pharmaceutical Journal
Vol 269 No 7224 p705
16 November 2002

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JAMA (jama.ama-assn.org)

Adding abciximab and reteplase does not reduce coronary deaths

Abciximab and reteplase combination therapy does not reduce mortality over one year, new data show. However, it represents a therapeutic advance with regard to non-fatal outcomes, researchers say.

The data are part of a one-year follow-up of the global use of strategies to open coronary arteries (GUSTO V) trial which compared the efficacy of abciximab and a half-dose of reteplase (combination therapy) with full-dose reteplase in 16,588 patients with acute myocardial infarction. Lower rates of non-fatal reinfarction, recurrent ischaemia and clinically important arrhythmias during hospital stay were observed in patients given combination therapy, but significantly lower mortality rates were not found at 30 days.

In the current analysis (GUSTO V), the researchers examined whether the early benefits with combination therapy seen in the trial would translate into a significant reduction in the risk of death after one year.

Deaths from all causes occurred in 692 of the 8,260 patients in the reteplase group and 698 of the 8,328 patients in the combination therapy group at one year. Reinfarction within seven days of randomisation was higher in the reteplase group and was found to be associated with one-year mortality. The researchers comment that the 30-day and one-year results together validate the combination therapy as the first alternative reperfusion strategy that is at least as effective as traditional fibrinolysis for acute myocardial infarction. "Selection of combination therapy for clinical use must be based on the perceived balance of benefit from reduced non-fatal ischaemic complications versus risk of increased bleeding in individual patients," they say (JAMA 2002;288:2130).

The National Institute for Clinical Excellence recently published guidance on thrombolytic drugs (PJ, 2 November, p633).