A systematic review update of the clinical effectiveness and cost-effectiveness of glycoprotein IIb/IIIa antagonists
BackgroundThis systematic review focused on the use of glycoprotein antagonists as part of the medical management of non-ST-elevation acute coronary syndrome in conjunction with aspirin and heparin, and as an adjunct to percutaneous coronary intervention in various groups of patients, both updates of previous reviews. In addition this review looked at glycoprotein antagonists as a supplement to thrombolytic therapy in patients with acute myocardial infarction.
Most of the trials found were conducted in the USA, therefore the conclusions should be considered within the limits of generalisation to the UK setting. The conclusions drawn from the update were that the effectiveness of glycoprotein antagonists as adjuncts to percutaneous coronary intervention were further confirmed by additional large studies showing similar effect sizes and bleeding rates; there was no evidence for the clinical superiority of tirofiban or eptifibatide over abciximab; drug costs of the newer agents are somewhat lower, however the evidence that glycoprotein antagonists are effective in non-ST-elevation acute coronary syndrome in situations when percutaneous coronary intervention is not undertaken is weakened by the publication of the GUSTO IV-ACS study; however, a recent meta-analysis of individual patient data from all major trials including GUSTO IV-ACS showed a small overall effect in such patients. Based on current evidence, it may be considered that the extra benefits of GPAs adjunctive to thrombolysis in AMI are not justified by the risks of extra bleeding.
Conducted by: M Robinson1, L Ginnelly2, M Sculpher2, L Jones3, R Riemsma3, S Palmer2, Z Philips2, J Glanville3
1. Nuffield Institute for Health, University of Leeds; 2. Centre for Health Economics; 3. NHS Centre for Reviews and Dissemination
Further detailsProject page on HTA Programme website
Related guidanceCommissioned to inform NICE Technology Appraisal 47: Glycoprotein IIb/IIIa inhibitors in the treatment of acute coronary syndromes. London: National Institute for Clinical Excellence; 2002
PublicationsRobinson M, Ginnelly L, Sculpher M, Jones L, Riemsma R, Palmer S, Philips Z, Glanville J. A systematic review update of the clinical effectiveness and cost-effectiveness of glycoprotein IIb/IIIa antagonists. Health Technol Assess. 2002;6(25):1-160
Commissioned by the HTA Programme on behalf of NICE