The FDA has approved GE HealthCare's Flyrcado (flurpiridaz F 18) injection, a novel positron emission tomography (PET) myocardial perfusion imaging (MPI) agent, for diagnosing coronary artery disease (CAD). This approval marks a significant advancement in nuclear cardiology, offering improved diagnostic accuracy compared to traditional single-photon emission computed tomography (SPECT) MPI.
Enhanced Diagnostic Accuracy and Clinical Impact
Flyrcado demonstrated superior efficacy compared to SPECT and was validated against coronary angiography in the AURORA Phase III trial. The agent's longer half-life of 109 minutes, significantly longer than other PET MPI tracers, allows for off-site manufacturing and distribution, potentially expanding access to cardiac PET imaging. According to Jamshid Maddahi, MD, FACC, MASNC, principal investigator of the Flyrcado clinical trials, this new radiotracer is "the most exciting development in the field of nuclear cardiology over the past few decades" and a potential "game changer" for diagnosing CAD.
Addressing a Critical Need in Cardiac Care
Coronary artery disease is the most common form of heart disease, accounting for 371,506 deaths in the United States in 2022. An estimated one in every 20 adults over 20 years of age in the United States have CAD. The availability of Flyrcado is poised to address a critical unmet need for more accurate and accessible diagnostic tools. The new agent is expected to improve diagnostic accuracy, particularly in difficult-to-image patients, such as those with a high body mass index (BMI) and women.
Key Features and Benefits of Flyrcado
- Improved Diagnostic Efficacy: Flyrcado delivers higher diagnostic efficacy compared to SPECT MPI. Sensitivity of Flyrcado PET MPI ranged from 74% to 89%, and specificity ranged from 53% to 70%.
- Extended Half-Life: With a half-life of 109 minutes, Flyrcado removes the need for on-site tracer production and enables distribution to a wider network of hospitals and imaging centers.
- Exercise Stress Testing: Flyrcado brings the first practical opportunity to combine exercise stress testing with cardiac PET imaging for CAD.
- Unit Dose Availability: Flyrcado can be ordered as a unit dose, offering convenience to imaging institutions and patients.
Clinical Trial Data and Safety Profile
The regulatory action was based on findings from the AURORA Phase III trial, in which Flyrcado was compared with both invasive coronary angiography and SPECT MPI. Common adverse events included dyspnea, headache, angina pectoris, chest pain, fatigue, ST segment changes, flushing, nausea, abdominal pain, dizziness, and arrhythmia. In Study 1, the sensitivity of Flyrcado PET MPI for detection of significant CAD ranged from 74% to 89%, while specificity ranged from 53% to 70%. In Study 2, sensitivity ranged from 63% to 77%, and specificity ranged from 66% to 86%.
Future Availability and Market Impact
Flyrcado is expected to launch in the United States early next year. Kevin O’Neill, CEO of the Pharmaceutical Diagnostics (PDx) segment of GE HealthCare, stated that Flyrcado can make a real difference to clinicians and their patients, marking another example of GE HealthCare’s commitment to innovation in molecular imaging. The introduction of Flyrcado is anticipated to shift the balance in nuclear cardiology, leveraging the existing network of cyclotrons that distribute FDG tracers for oncology, allowing more widespread use of PET for cardiac imaging.
