Self-Administered Etripamil Nasal Spray Treats Tachycardia, Study Suggests

A recent secondary analysis of a randomized clinical trial has indicated the success of self-administered etripamil in treating paroxysmal supraventricular tachycardia (PSVT) outside the hospital.1

PSVT has long been treated through oral prophylaxis with various antiarrhythmic drugs. However, in taking these drugs and drug combinations, patients run the risk of adverse effects. Additionally, despite optimal administration of and compliance with treatment, relapses are not uncommon.2

“Self-administered etripamil was nearly twice as likely as placebo to terminate a PSVT episode within 30 minutes,” wrote Sean Pokorney, MD, MBA, department of medicine, Duke University School of Medicine, and colleagues. “Self-administered, outpatient-based treatment for PSVT could contribute to reduced emergency department (ED) visits and cost and complexity of care.”1

Investigators examined data from the NODE-301 Phase 3 trial, which investigated the efficacy and safety of etripamil nasal spray for treating PSVT. After receiving a test dose, participants were randomized 2:1 to receive either etripamil 70 mg or placebo. When symptoms of PSVT developed, patients applied a cardiac monitor and attempted a vagal maneuver. If symptoms continued, patients would self-administer blinded treatment.3

Although NODE-301 failed to reach its primary 5-hour efficacy endpoint, etripamil was deemed safe and well-tolerated based on the data collected. In the second part, RAPID, patients were administered a repeat dose of etripamil 70 mg 10 minutes after the first dose if symptoms persisted. Patients were advised to seek medical care if they did not resolve within 30 minutes after study drug administration.1

Investigators examining both trials collected data on patients seeking emergency care within 24 hours of treatment, and X2 tests were performed on pooled data to determine statistical significance between the placebo and etripamil cohorts. Two-sided P <.05 indicated statistical significance.1

In total, 370 patients attempted vagal maneuvers during PSVT episodes before drug administration. Among these, only 17 (4.6%) had PSVT termination. The pooled cohort comprised 340 patients with a mean age of 54.7 years, and 69.7% were female. Overall, 206 patients received etripamil and 134 received placebo.1

PSVT termination was confirmed in 119 patients (57.8%) within 30 minutes of using etripamil compared with 43 (32.1%) using placebo (P <.001). Further analysis showed 34 patients (25.4%) in the placebo cohort and 30 (14.6%) in the etripamil cohort received additional intervention in the form of oral or intravenous medications (P = .01). Only 28 of 206 (13.6%) etripamil recipients required an ED visit for ongoing PSVT symptoms, versus 30 of 134 placebo recipients (22.4%). This demonstrated an absolute risk reduction of 8.8% and a relative risk (RR) reduction of 39% (RR, 0.61; 95% CI, .38-.97, P = .04).1

Given these data, Pokorney and colleagues indicated that etripamil has a substantially better rate of PSVT treatment than either vagal maneuvers or oral medications. Widespread acceptance of self-administered etripamil treatment could lead to reduced financial burden on patients and fewer ED visits.

“Limitations included pooling the studies for statistical power,” Pokorney and colleagues wrote. “Future analyses of etripamil’s implications for ED visits would broaden the applicability of results.”1

References

1. Pokorney SD, Camm AJ, Dorian P, et al. Self-administered etripamil and emergency department visits in supraventricular tachycardia. JAMA Cardiology. Published online April 9, 2025. doi:10.1001/jamacardio.2025.0417

2. Alboni P, Tomasi C, Menozzi C, et al. Efficacy and safety of out-of-hospital self-administered single-dose oral drug treatment in the management of infrequent, well-tolerated paroxysmal supraventricular tachycardia. Journal of the American College of Cardiology. 2001;37(2):548-553. doi:10.1016/s0735-1097(00)01128-1

3. Stambler BS, Plat F, Sager PT, et al. First randomized, Multicenter, placebo-controlled study of self-administered intranasal etripamil for acute conversion of spontaneous paroxysmal supraventricular tachycardia (node-301). Circulation: Arrhythmia and Electrophysiology. 2022;15(12). doi:10.1161/circep.122.010915