Reviwer : Dr. Cem Çöteli

Name of the Study :
Etripamil Nasal Spray Relieves Symptoms and Reduces Emergency Room Interventions in Patients with Paroxysmal Supraventricular Tachycardia (PSVT)

Published in Congress : ACC 2021

Link : not published yet

Literature :
Etripamil is a novel L-type calcium channel blocker. It is administered as a rapidly acting nasal spray and developed as a self-administered therapy to terminate AV nodal-dependent PSVT.

Aim :
The authors aimed to investigate the superiority of etripamil over placebo in terminating PSVT events in the outpatient setting

Method :
The NODE-301 trial is a multicenter phase 3 efficacy and safety study of etripamil nasal spray.  Four hundred nineteen patients were randomized to etripamil:placebo (2:1). One hundred ninety eight of 419 patients used the drugs they got when they suspected the SVT episode. Only 156 of 198 were positively adjudicated PSVT events. The primary outcome was the efficacy of etripamil with placebo. The secondary clinical endpoints were relief of specific PSVT-related symptoms, patient-reported satisfaction with treatment, need for emergency room (ER) medical interventions, and need for additional rescue medical therapy.

Results :
One hundred seven patients and 49 patients used etripamil and placebo when they feel true PSVT events, respectively. The time to conversion of positively adjudicated PSVT episodes over 5 hours was not significantly different between groups (HR (95% CI) 1.086 (0.726, 1.623) p=0.1212). However, the efficacy of etripamil was better than placebo for over 45 minutes (HR (95% CI) 1.668 (1.026, 2.712) p=0.02). The relief of PSVT symptoms was also better in the etripamil group. The time to ER intervention occurred later in the etripamil than placebo group (116±14 vs. 79±10 min, p<0.05)

Conclusion :
The 301 NODE trial showed that etripamil significantly improved PSVT-related symptoms, and etripamil tended to reduce the need for emergency room medical interventions for PSVT.

Interpretation :
The recent guidelines suggest ablation therapies for PSVT. On the other hand, if the patients do not prefer invasive procedures or they had failed procedures, they could be symptomatic. We do not have rapidly acting effective drugs for PSVT elimination except adenosine. But adenosine must be administered intravenously. So, the patients with PSVT need to go to the emergency room mostly. I believe the 301- NODE trial’s data support the continued development of etripamil nasal spray for acute treatment of PSVT.