An update on nesiritide for treatment of decompensated heart failure

In the July 1999 issue of this publication, we described the chemical prope rties, pharmacology and clinical trials involving nesiritide as a therapeut ic agent for patients with decompensated heart failure (Exp. Opin. Invest. Drugs) (1999) 8(7):1063-1072. At the time of publication, the US Food and D rug Administration reviewed the clinical experience with the compound and d id not approve the drug for clinical use. More data were requested regardin g safety issues, comparison with nitroglycerine, onset of effects, need for invasive haemodynamic monitoring and symptomatic: improve ment. The VMAC S tudy was designed to address these issues. A dosing regiment 0.2 mug/kg bol us followed by 0.01 mug/kg/min continuous infusion, was chosen to provide r apid onset of actions and haemodynamic improve ment without a high incidenc e of symptomatic hypotension. Nesiritide was superior to iv, nitroglycerine in its haemodynamic effects, easier to administer without the need for dos e titration and better tolerated overall. The drug could be administered sa fely without the need for invasive haemodynamic monitoring. Symptomatic hyp otension occurred in 4% of patients. Beneficial haemodynamic effects correl ated with symptomatic improvement in heart failure patients. Nesiritide app ears to be an ideal first-line agent for treatment of patients with acutely decompensated heart failure.