Abciximab reduces events in PCI patients

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The Pharmaceutical Journal
Vol 276 No 7392 p312
18 March 2006

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Abciximab reduces events in PCI patients

Abciximab (ReoPro) reduces the risk of events in patients with non-ST-segment elevation acute coronary syndromes (ACS) undergoing percutaneous coronary intervention (PCI) even after pretreatment with 600mg of clopidogrel (Plavix), a new study has shown.

Treatment regimen

Abciximab group Patients were treated with an abciximab bolus (0.25mg/kg) followed by a 12-hour infusion (0.125µg/kg/min to a maximum of 10µg/min) plus heparin bolus (70U/kg)

Placebo group Patients were given a placebo bolus and 12-hour infusion plus heparin bolus (140U/kg).

All patients were given clopidogrel (600mg) at least two hours before PCI, as well as 500mg of oral or intravenous aspirin.

The study (known as ISAR-REACT 2) randomised 2,022 patients, mean age 66 years, with non-ST-segment elevation ACS undergoing PCI to abciximab or placebo (see Panel). The combined endpoint of death, myocardial infarction, or urgent target vessel revascularisation within 30 days of randomisation, was reduced by 25 per cent in patients treated with abciximab (8.9 per cent versus 11.9 per cent in the placebo group; relative risk 0.75, 95 per cent confidence interval 0.58-0.97; P=0.03).

Subgroup analysis revealed no significant difference in the incidence of events with the two treatment options for patients showing no elevation in troponin levels. In contrast, the event rate was lower with abciximab for patients with elevated troponin levels.

The trial, which is also published online in JAMA (13 March), showed no significant differences between the two treatment groups in risk of major bleeding (1.4 per cent in both groups), minor bleeding (4.2 per cent with abciximab versus 3.3 per cent with placebo), or need for transfusion (2.5 per cent versus 2.0 per cent).

Helen Williams, pharmacy team leader, cardiac services, King’s College Hospital NHS Trust, London, said: “In contrast to ISAR-REACT 1, ISAR-REACT 2 identified that a 600mg pre-loading dose of clopidogrel is not enough.” She noted that, although ISAR-REACT 2 used abciximab as the antithrombotic agent, another study reported at the meeting suggested that bivalirudin (Angiox) was equally effective, with a lower bleeding risk than glycoprotein IIb/IIIas in this setting.