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2017 ; 38
(15
): 1119-1127
Nephropedia Template TP
gab.com Text
Twit Text FOAVip
Twit Text #
English Wikipedia
Vericiguat in patients with worsening chronic heart failure and preserved
ejection fraction: results of the SOluble guanylate Cyclase stimulatoR in heArT
failurE patientS with PRESERVED EF (SOCRATES-PRESERVED) study
#MMPMID28369340
Pieske B
; Maggioni AP
; Lam CSP
; Pieske-Kraigher E
; Filippatos G
; Butler J
; Ponikowski P
; Shah SJ
; Solomon SD
; Scalise AV
; Mueller K
; Roessig L
; Gheorghiade M
Eur Heart J
2017[Apr]; 38
(15
): 1119-1127
PMID28369340
show ga
AIMS: To determine tolerability and the optimal dose regimen of the soluble
guanylate cyclase stimulator vericiguat in patients with chronic heart failure
and preserved ejection fraction (HFpEF). METHODS AND RESULTS: SOCRATES-PRESERVED
was a prospective, randomized, placebo-controlled double-blind, Phase 2b
dose-finding study in patients with HFpEF (ejection fraction?? 45%). Patients
received vericiguat once daily at 1.25 or 2.5?mg fixed doses, or 5 or 10?mg
titrated from a 2.5?mg starting dose, or placebo for 12 weeks. The two primary
endpoints were change from baseline in log-transformed N-terminal pro-B-type
natriuretic peptide (NT-ProBNP) and left atrial volume (LAV) at 12 weeks.
Patients (N?=?477; 48% women; mean age 73?±?10 years; baseline atrial
fibrillation 40%) were randomized within 4 weeks of HF hospitalization (75%) or
outpatient treatment with intravenous diuretics for HF (25%) to vericiguat
(n?=?384) or placebo (n?=?93). In the pooled three highest dose arms change in
logNT-proBNP (vericiguat:?+0.038?±?0.782 log(pg/mL), n?=?195;
placebo:?-0.098?±?0.778 log(pg/mL), n?=?73; one-sided P?=?0.8991, two-sided
P?=?0.2017), and change in LAV [vericiguat: -1.7?±?12.8?mL (n?=?194); placebo:
?-3.4?±?12.7?mL (n?=?67), one-sided P?=?0.8156, two-sided P?=?0.3688] were not
different from placebo. Vericiguat was well tolerated (adverse events: vericiguat
10?mg arm, 69.8%; placebo, 73.1%), with low discontinuation rates in all groups,
and no changes in blood pressure at 10?mg compared with placebo. The
pre-specified exploratory endpoint of Kansas City Cardiomyopathy Questionnaire
Clinical Summary Score improved in the vericiguat 10?mg arm by mean 19.3?±?16.3
points [median 19.8 (interquartile range 10.4-30.7)] from baseline (mean
difference from placebo 9.2 points). CONCLUSION: Vericiguat was well tolerated,
did not change NT-proBNP and LAV at 12 weeks compared with placebo but was
associated with improvements in quality of life in patients with HFpEF. Given the
encouraging results on quality of life, the effects of vericiguat in patients
with HFpEF warrant further study, possibly with higher doses, longer follow-up
and additional endpoints.