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DG DISPATCH - ACC: Eptifibatide Better Than Placebo For Preventing Stent Complications By Edward Susman Special to DG News ANAHEIM, CA -- March 16, 2000 -- Researchers report that the glycoprotein IIB/IIIA inhibitor, eptifibatide (Integrilin), can reduce the incidence of death and heart attack and the need for urgent revascularization procedures significantly better than placebo. However, doctors say the lower cost of eptifibatide when compared to the current standard of care in prevention of in-stent thrombosis -- abciximab (ReoPro) -- may prove to be the most important aspect of the ESPRIT trial. "This is really a landmark study that is going to change the way we practice medicine," Dr. Eugene Braunwald, vice president for academic programs at Boston's Partners HealthCare Systems, said on March 15, 2000, at the American College of Cardiology meeting, in Anaheim, CA. In the ESPRIT (Enhanced Suppression of the Platelet Receptor glycoprotein IIb/IIIa using Integrilin Therapy) trial, Dr. James Tcheng, associate professor of medicine at Duke University Medical Center, in Durham, NC, reported that eptifibatide reduced the risk of major complications during angioplasty by 40 percent in the first 48 hours following the procedure. About 700,000 angioplasty procedures are performed each year in the United States and more than 80 percent of those minimally-invasive operations involve the placement of the stainless steel coils known as stents. For several years, doctors have been adding glycoprotein IIB/IIIAinhibitors to prevent the complications that can occur with stent placement. The most frequently used drug for this purpose is abciximab. Tcheng said that because abciximab is expensive -- about $1,500 a dose -- many doctors do not use the drug. In fact, he said, only 25 percent of patients who would be eligible for IIB/IIIA are getting the treatment, suggesting that cost is a major deterrent to use of this preventive treatment. Eptifibatide dosing was about $400 per patient in the ESPRIT trial, Tcheng said. He suggested that eptifibatide "eliminates financial barriers to use of the drugs and should lead to changes in medical practice. In our laboratory, we have already switched to using eptifibatide." However, Tcheng said that before recommendations on use of eptifibatide can be made, he said doctors should wait until the ESPRIT trial investigators look at 30 day and later data. Dr. Lawrence Deckelbaum, executive director of cardiovascular clinical research for the manufacturer of abciximab, Centocor Corp., Malvern, Penn., said, "For doctors the focus should still remain on safety and efficacy of the drugs. As Dr. Tcheng said, the results announced are an incomplete picture. We know that with ReoPro there is a mortality benefit at one year. We know that with ReoPro there is a mortality benefit for diabetics. And ReoPro has an excellent safety profile." Tcheng noted that the study compared eptifibatide to patients receiving no IIB/IIIA drugs. It was not a head-to-head comparison with abciximab. Related Links: eptifibatide (Integrilin), abciximab (ReoPro) and Centocor Corp E-mail this page to a friend or colleague! To print, use this version