Efficacy and Safety of Etripamil for Termination of Spontaneous PSVT - RAPID

Jul 19, 2023
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Author/Summarized by Author:
Anthony A. Bavry, MD,MPH,FACC
Summary Reviewer:
Kim A. Eagle, MD, MACC
Trial Sponsor:
Milestone Pharmaceuticals
Date Published:
06/15/2023
Date Updated:
07/19/2023
Original Posted Date:
07/19/2023
References

Contribution To Literature:

The RAPID trial showed that self-administered etripamil improves conversion of paroxysmal supraventricular tachycardia to normal sinus rhythm.

Description:

The goal of the trial was to evaluate etripamil, a novel L-type calcium channel blocker, compared with placebo among outpatients with paroxysmal supraventricular tachycardia (PSVT). Etripamil is a self-administered nasal spray.

Study Design

  • Randomized
  • Parallel

The RAPID study is part 2 of the NODE-301 study. Patients with documented PSVT were randomized to etripamil 70 mg (n = 135) versus placebo (n = 120).

  • Total number of enrollees: 692 (only patients with a documented PSVT during follow-up were included for analysis)
  • Mean patient age: 56 years
  • Percentage female: 73%

Inclusion criteria:

  • Patients aged ≥18 years and a history of PSVT with sustained, symptomatic episodes (≥20 minutes)

Exclusion criteria:

  • Pre-excitation on electrocardiogram
  • Second-degree or third-degree atrioventricular (AV) block
  • Ventricular arrhythmia
  • Atrial arrhythmia not involving the AV node

 

Principal Findings:

The primary outcome, conversion rates by 30 minutes were 64% with etripamil vs. 31% with placebo (p < 0.0001)

Secondary outcomes:

  • Adverse events occurring in ≥5% of patients treated with etripamil were nasal discomfort (23%), nasal congestion (13%), and rhinorrhea (9%).

Interpretation:

Among patients with PSVT, self-administered etripamil improves conversion to normal sinus rhythm compared with placebo. Etripamil was generally well tolerated. This medicine may allow patients to treat themselves and avoid intravenous medications in an acute care setting.

References:

Stambler BS, Camm AJ, Alings M, et al. Self-administered intranasal etripamil using a symptom-prompted, repeat-dose regimen for atrioventricular-nodal-dependent supraventricular tachycardia (RAPID): a multicenter, randomized trial. Lancet 2023;402:118-28.

Clinical Topics: Arrhythmias and Clinical EP, Prevention, Implantable Devices, EP Basic Science, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias

Keywords: Arrhythmias, Cardiac, Arrhythmia, Sinus, Atrioventricular Node, Calcium Channel Blockers, Nasal Decongestants, Nasal Sprays, Outpatients, Rhinorrhea, Secondary Prevention, Tachycardia, Paroxysmal, Tachycardia, Supraventricular


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