arznei-telegramm 2002; 33: 87


Equivalence of Abciximab (REOPRO) and Tirofiban (AGGRASTAT) Following Stent Implantation: As a surprise came the findings of the first direct comparative study of two gycoprotein IIb/IIIa inhibitors in the setting of coronary angioplasty with stent implantation: Contrary to expectations, at 30 days of trial, the results favoured abciximab over tirofiban (TOPOL, E.J., et al.: NEJM 2001; 344: 1888-94; a-t 2001; 32: 68, ;73). The reduction of the primary endpoint (death, myocardial infarction or revascularization; 6% vs. 7.6%) was primarily due to a lower incidence of myocardial infarctions (5.4% vs. 6.9%). Yet, the pre-planned follow-up evaluation of the TARGET*-study after six months does not show advantages for abciximab anymore. The reduced rate of infarctions under abciximab is seen only during the first two days following angioplasty. While the lower infarction rate tends to persist throughout the period of observation (6.6% vs. 8.0%), there is a trend towards increased risk of revascularization procedures under abciximab. Thus the figures of the composite primary endpoint approach equality (14.3% vs. 14.8%). These contrary tendencies appear even more obvious in the subgroup of patients who underwent angioplasty due to an acute coronary syndrome. However, even in this group, there is no statistically significant advantage for abciximab (MOLITERNO, D.J. et al.: Lancet 2002; 360: 355-60). The detailed results support the assumption that dosage recommendations for tirofiban require adjustment. For practical consequences, the probably most important outcome of the study is the mortality rate remaining nearly the same in both groups over the entire time of observation. Therefore, both agents can be considered equally effective. Accordingly, they are recommended by the US-American ACCP** guidelines as equivalent alternatives (Chest 2001; 119: 321S-36S). In view of the significantly lower costs associated with tirofiban, this fact is of considerable economic importance.


TARGET = Do Tirofiban and REOPRO Give Similar Efficacy Trial


ACCP = American College of Chest Physicians

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