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Rapid Responses to:
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Electronic letters published:
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The Dry Pipeline of Antiarrythmic Therapies
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Amnon Schlegel, MD, PhD Univesity of California, San Francisco
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aschlege{at}itsa.ucsf.edu Amnon Schlegel
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To the Editor: Zimetbaum and Josephson are confident that "new approaches to drug development and screening for risk for adverse events may ultimately reduce the toxicity of these agents (1)." Unfortunately, this optimism has fallen on deaf ears in the pharmaceutical industry: the only "new" drugs to treat atrial fibrillation are dofetilide, ibutilide, and azimilide (2,3). These class III antiarrythmics, far from being bold breakthroughs in the management of atrial fibrillation, are "niche" players (2) whose long-term efficacy and toxicity are matters of speculation (3). The remaining antiarrythmics the authors advocate for those who fail rate control, have contraindications to systemic anticoagulation, or who were otherwise excluded from the AFFIRM study based on age or comorbidites(4); have very high toxicities including lethal arrhythmias. Furthermore, their dosing is a matter of heated debate, and their monitoring is difficult and expensive. Large trials using the "hybrid" therapies they advocate should be organized to determine if the combination of expensive and marginally therapeutic drugs and ablative procedures are better than rate control (4,5). References: 1. Zimetbaum P, Josephson ME. Is there a role for maintaining sinus rhythm in patients with atrial fibrillation? Ann Intern Med. 2004;141:720-6 2. Sing BN, Sarma, JSM. What niche will newer class III antiarrythmic drugs occupy? Curr Cardiol Rep. 2001;3:314-23. [PMID: 11406090] 3. Naccarelli GV, Wolbrette DL, Bhatta L, Khan M, Hynes J, Samii S, Luck J. A review of clinical trials assessing the efficacy and safety of newer antiarrhythmic drugs in atrial fibrillation. J Interv Card Electrophysiol. 2003;9:215-22. [PMID: 14574034] 4. Wyse DG, Waldo AL, DiMarco JP, Domanski MJ, Rosenberg Y, Schron EB, et al.. A comparison of rate control and rhythm control in patients with atrial fibrillation. N Engl J Med. 2002;347:1825-33. [PMID: 12466506] 5. Marshall DA, Levy AR, Vidaillet H, et al. Cost- Effectiveness of Rhythm versus Rate Control in Atrial Fibrillation. Ann Intern Med. 2004; 141:653-661. Conflict of Interest:None declared |
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