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(Circulation. 2003;108:e9018.)
© 2003 American Heart Association, Inc.

Cardiovascular News

Ruth SoRelle, MPH

Circulation Newswriter

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Complement Inhibitor Has Little Effect in Either COMMA or COMPLY

Two reports on studies using the complement-inhibitor pexelizumab in this week’s issue of the journal Circulation cast doubt on the drug’s future. It appeared to have no effect on the size of infarct and equivocal effect on mortality in the patients suffering acute myocardial infarction. Complement is implicated in the inflammatory pathways associated with damage in myocardial infarction, and as an inhibitor, pexelizumab was expected to short-circuit the harm caused by the process.

In the COMMA trial (COMplement inhibition in Myocardial infarction treated with Angioplasty; Circulation. 2003;108:1184–1190), 960 patients with ST-segment–elevated myocardial infarction who were scheduled to undergo angioplasty were randomized to placebo, 2-mg/kg bolus of pexelizumab, or 2-mg/kg bolus of pexelizumab with 0.05-mg/kg infusion hourly for 20 hours. The treatment had no effect on infarct size, wrote the investigators, with Christopher Granger, MD, of Duke Clinical Research Institute in Durham, NC, as the lead author. Nor did the treatment have a significant effect on 90-day death, new or worsening heart failure, shock, or stroke. The 90-day mortality rate was lower in the pexelizumab group that received bolus in infusion—1.8% versus 5.9% in the placebo group. The bolus-alone group’s mortality rate was 4.2%. The bolus-plus-infusion group’s mortality rate was significantly lower than that of the placebo group.

The authors noted that although the treatment appeared to have no effect on infarct size, the lower death rate in the pexelizumab bolus–plus-infusion group indicates that the treatment may benefit patients by an alternative mechanism that deserves further study.

The authors wrote: . . . [Full Text of this Article]