Intraventricular not superior to oral nimodipine for subarachnoid haemorrhage

In the treatment of patients with aneurysmal subarachnoid haemorrhage, administering the nimodipine via the intraventricular route does not provide greater benefits as compared with the oral route, a recent study has shown.

Researchers recruited patients with World Federation of Neurological Surgeons grades 2–4, modified Fisher grades 2–4, and had an external ventricular drain inserted as part of standard of care. Of the patients, 144 received EG-1962, a sustained release formulation of nimodipine administered via external ventricular drain, and 145 standard of care oral nimodipine.

The study was discontinued prematurely following a planned interim analysis of 210 patients, being unlikely to achieve its primary endpoint of the proportion of patients with favourable outcome at day 90, measured using the extended Glasgow outcome scale 6–8. The proportion was 45 percent (n=65) in the EG-1962 group and 42 percent (n=62) in the oral group (risk ratio, 1.01, 95 percent confidence interval [CI], 0.83–1.22; p=0.95).

However, EG-1962 produced a significant reduction in the number of patients with vasospasm (50 percent vs 63 percent; p=0.025) and hypotension (7 percent vs 10 percent).

Further analysis revealed that EG-1962 was somehow effective in the subgroup of patients with World Federation of Neurological Surgeons 3–4 (46 percent vs 32 percent with oral nimodipine; odds ratio, 1.22, 95 percent CI, 0.94–1.58; p=0.13).

The safety profile of EG-1962 was acceptable.