The Pharmaceutical Journal
Vol 269 No 7227 p803
7 December 2002

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American Heart Association: Scientific sessions (www.scientificsessions.org)

Antibody fragment reduces mortality

A new drug, originally designed to reduce cell death that occurs during reperfusion therapy following myocardial infarction (MI), has been shown to reduce mortality in patients undergoing angioplasty despite not having an effect on cell death.

Pexelizumab, an antibody fragment that inhibits a protein involved in the complement cascade, was tested for its effect on infarct size. "The rationale for the trial was to use this targeted drug to inhibit a particular part of the complement cascade to decrease the amount of inflammatory damage when blood flow is restored," Dr Christopher Granger, Duke University Medical Centre, North Carolina, said.

Overall, 1,903 patients with ST-elevation acute MI took part in the study and were randomised to receive either pexelizumab or placebo and to two different reperfusion strategies — thrombolysis or angioplasty.

Pexelizumab failed to have an effect on infarct size with either of the reperfusion strategies used. However, in patients randomised to angioplasty and treated with pexelizumab (as a bolus plus infusion) there was a reduction in all-cause mortality at 90 days compared with placebo (1.8 per cent versus 5.9 per cent, P=0.014).

"This is the first trial in more than a decade to show a reduction in mortality when [a new therapy] is added to standard heart attack treatment. This suggests that pexelizumab may be having a clinical benefit using an entirely different mechanism," Dr Granger added.

Data from the trial, known as the complement and reduction of infarct size after angioplasty or lytics (CARDINAL) programme, were presented at the American Heart Association scientific sessions held in Chicago last month.