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Camm AJ, Piccini JP, Alings M, Dorian P, Gosselin G, Guertin MC, Ip JE, Kowey PR, Mondésert B, Prins FJ, Roux JF, Stambler BS, van Eck JWM, Al Windy N, Thermil N, Shardonofsky S, Bharucha DB, Roy D. Multicenter, Phase 2, Randomized Controlled Study of the Efficacy and Safety of Etripamil Nasal Spray for the Acute Reduction of Rapid Ventricular Rate in Patients With Symptomatic Atrial Fibrillation (ReVeRA-201). Circ Arrhythm Electrophysiol 2023; 16:639-650. [PMID: 37950726 PMCID: PMC10734780 DOI: 10.1161/circep.123.012567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 11/07/2023] [Indexed: 11/13/2023]
Abstract
BACKGROUND Despite chronic therapies, atrial fibrillation (AF) leads to rapid ventricular rates (RVR) often requiring intravenous treatments. Etripamil is a fast-acting, calcium-channel blocker administered intranasally affecting the atrioventricular node within minutes. METHODS Reduction of Ventricular Rate in Patients with Atrial Fibrillation evaluated the efficacy and safety of etripamil for the reduction of ventricular rate (VR) in patients presenting urgently with AF-RVR (VR ≥110 beats per minute [bpm]), was randomized, double-blind, placebo-controlled, and conducted in Canada and the Netherlands. Patients presenting urgently with AF-RVR were randomized (1:1, etripamil nasal spray 70 mg: placebo nasal spray). The primary objective was to demonstrate the effectiveness of etripamil in reducing VR in AF-RVR within 60 minutes of treatment. Secondary objectives assessed achievement of VR <100 bpm, reduction by ≥10% and ≥20%, relief of symptoms and treatment effectiveness; adverse events; and additional measures to 360 minutes. RESULTS Sixty-nine patients were randomized, 56 dosed with etripamil (n=27) or placebo (n=29). The median age was 65 years; 39% were female patients; proportions of AF types were similar between groups. The difference of mean maximum reductions in VR over 60 minutes, etripamil versus placebo, adjusting for baseline VR, was -29.91 bpm (95% CI, -40.31 to -19.52; P<0.0001). VR reductions persisted up to 150 minutes. Significantly greater proportions of patients receiving etripamil achieved VR reductions <100 bpm (with longer median duration <100 bpm), or VR reduction by ≥10% or ≥20%, versus placebo. VR reduction ≥20% occurred in 66.7% of patients in the etripamil arm and no patients in placebo. Using the Treatment Satisfaction Questionnaire for Medication-9, there was significant improvement in satisfaction on symptom relief and treatment effectiveness with etripamil versus placebo. Serious adverse events were rare; 1 patient in the etripamil arm experienced transient severe bradycardia and syncope, assessed as due to hypervagotonia. CONCLUSIONS Intranasal etripamil 70 mg reduced VR and improved symptom relief and treatment satisfaction. These data support further development of self-administered etripamil for the treatment of AF-RVR. REGISTRATION URL: https://www.clinicaltrials.gov; Unique Identifier: NCT04467905.
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Affiliation(s)
- A. John Camm
- Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St. George’s University of London, United Kingdom (A.J.C.)
| | - Jonathan P. Piccini
- Duke University Medical Center and Duke Clinical Research Institute, Durham, NC (J.P.P.)
| | - Marco Alings
- Department of Cardiology, Amphie Hospital, Breda, the Netherlands (M.A.)
| | - Paul Dorian
- Division of Cardiology, Unity Health Toronto, Ontario, Canada (P.D.)
| | - Gilbert Gosselin
- Department of Medicine, Montreal Heart Institute, Québec, Canada (G.G., M.-C.G., B.M., D.R.)
| | - Marie-Claude Guertin
- Department of Medicine, Montreal Heart Institute, Québec, Canada (G.G., M.-C.G., B.M., D.R.)
| | - James E. Ip
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York Presbyterian Hospital (J.E.I.)
| | - Peter R. Kowey
- Cardiology Division and Lankenau Institute for Medical Research, Lankenau Medical Center, Wynnewood, PA (P.R.K.)
| | - Blandine Mondésert
- Department of Medicine, Montreal Heart Institute, Québec, Canada (G.G., M.-C.G., B.M., D.R.)
| | | | - Jean-Francois Roux
- Centre Hospitalier de l’Université de Sherbrooke, Québec, Canada (J.-F.R.)
| | | | - JWM van Eck
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands (J.W.M.v.E.)
| | | | | | | | | | - Denis Roy
- Department of Medicine, Montreal Heart Institute, Québec, Canada (G.G., M.-C.G., B.M., D.R.)
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