Efficacy and safety of nesiritide in patients with decompensated heart failure: a meta-analysis of randomised trials

Abstract

ObjectivesCurrent evidence suggests that nesiritide may have effects on renal function and decrease the incidence of mortality. However, a clear superiority using nesiritide in terms of renal toxicity and mortality in patients with heart failure was not consistently proven by previous studies. We performed a meta-analysis of all randomised trials to obtain the best estimates of efficacy and safety of nesiritide for the initial treatment of decompensated heart failure.MethodWe performed a meta-analysis of randomised trials of nesiritide in patients with decompensated heart failure (n=38 064 patients, in 22 trials). Two reviewers independently extracted data. Data on efficacy and safety outcomes were collected. We calculated pooled relatives risk (RRs), weighted mean difference and associated 95% CIs.ResultsCompared with placebo, dobutamine and nitroglycerin, nesiritide indicated no increasing risk of total mortality. Compared with the combined control therapy, nesiritide was associated with non-significant differences in short-term mortality (RR 1.24; 95% CI 0.85 to 1.80; p=0.27), mid-term mortality (RR 0.86; 95% CI 0.60 to 1.24; p=0.42) and long-term mortality (RR 0.94; 95% CI 0.75 to 1.18; p=0.61). Nesiritide therapy increased the risk of hypotension (p<0.00 001) and bradycardia (p=0.02) when compared with control therapy. Compared with dobutamine or placebo therapy, no differences in serum creatinine, blood urea nitrogen and creatinine clearance, and no risk of the need for dialysis was observed in nesiritide therapy.ConclusionsOur findings indicated that, in patients with heart failure, nesiritide was not associated with the risk of mortality. However, it increased the risk of cardiovascular adverse events. The change of serum creatinine and creatinine clearance had no significant difference, and no risk of the need for dialysis was observed after low-dose nesiritide treatment.

The therapeutic effect of B‐type natriuretic peptides in acute decompensated heart failure

“…Recently, Gong et al 15 published the results of a meta‐analysis of randomized trials that investigated nesiritide use in patients with decompensated HF (n = 38 064 patients, in 22 trials). They revealed that nesiritide was not associated with a risk of mortality in patients with HF.…”

“…Even symptomatic improvements were only mildly demonstrated. Other, much smaller trials assessing infusions of NPs have been more positive, however 15,108 . Whether this can be explained by discrepancies in patient populations, doses or durations of treatment, only further studies will reveal.…”

The Management of Pediatric Heart Failure: Current State and Future Managements

“…In patients with low out-put syndrome, inotropic(s) and/or inodilator, such as levosimendan, are used to tory heart failure that showed nesiritide was associated with improved urine output, serum creatinine, and cardiac function [8,9]. However, trials in adults with acute decompensated heart failure have failed to show that nesiritide is associated with lower mortality or rehospitalization rate, or that it improves dyspnea.…”

Pharmacological approaches to cardio-renal syndrome: a role for the inodilator levosimendan

“… 29 ) Meta-analyses of clinical experience with nesiritide performed in 2005 and again in 2016 identified either a significantly increased risk of worsening renal function 30 or no obvious renal-protective benefit and some cardiovascular hazards (hypotension, bradycardia). 31 …”