PO-04-108 THE EFFICACY AND SAFETY OF ETRIPAMIL NASAL SPRAY FOR THE TREATMENT OF ACUTE PAROXYSMAL SUPRAVENTRICULAR TACHYCARDIA: A META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS

Abstract

Paroxysmal Supraventricular Tachycardia (PSVT) treatment requires medically supervised intervention. This is derived from the lack of effective and safe self-administrated treatment for PSVT. Etripamil is a novel short-acting calcium channel blocker with a rapid intranasal spray and shows promising potential for the unsupervised treatment of PSVT, especially in the dosage of 70 mg. We aim to evaluate the efficacy and safety of Etripamil for the acute conversion of PSVT. We conducted a systematic review and meta-analysis synthesizing randomized controlled trials (RCTs), which were retrieved by systematically searching: PubMed, EMBASE, Web of Science, SCOPUS, and Cochrane through December 1st, 2022. RevMan version 5.4 software was used to pool dichotomous outcomes using risk ratio (RR) presented with the corresponding confidence interval (CI) while using the fixed-effects model. Three RCTs with a total of 496 patients (296 in the etripamil group and 200 in the placebo group) were included in our analysis. Etripamil was effective for PSVT conversion at 15 minutes (RR: 1.84 with 95% CI [1.37, 2.48]), 30 minutes (RR: 1.86 with 95% CI [1.42, 2.44]), and at 60 minutes after the drug administration (RR: 1.25 with 95% CI [1.05, 1.50]); decreasing medical intervention seeking (RR: 0.58 with 95% CI [0.37, 0.90]); and decreasing emergency (ER) visits (RR: 0.61 with 95% CI [0.38, 0.97]). However, there was no difference at 300 minutes (RR: 1.10 with 95% CI [0.97, 1.25]). Also, Etripamil was associated with higher rates of the incidence of any adverse events (AEs) (RR: 3.17 with 95% CI [2.15, 4.69]), nasal discomfort (RR: 3.82 with 95% CI [2.01, 7.24]), nasal congestion (RR: 5.89 with 95% CI [1.93, 17.97]), epistaxis (RR: 4.74 with 95% CI [1.21, 18.50]), and rhinorrhea (RR: 3.53 with 95% CI [1.22, 10.26]) with no difference regarding any serious adverse events (SAEs) incidence (RR: 0.30 with 95% CI [0.01, 7.21]). Etripamil was effective in inducing PSVT termination for up to 60 minutes and reduced medical treatment seeking and ER visits. Also, Etripamil was associated with higher rates of AEs, including epistaxis, nasal congestion, and rhinorrhea; however, it was not associated with SAEs. Therefore, Etripamil constitutes a promising strategy for PSVT self-termination without medical supervision; however, further RCTs are required before endorsement in clinical practice.