Vericiguat in heart failure: From scientific evidence to clinical practice

Vericiguat in Heart Failure: Characteristics, Scientific Evidence and Potential Clinical Applications

“…All patients included in the VICTORIA trial had a recent episode of HFH, while the PARADIGM-HF and DAPA-HF trials only had rates of HFH of 62.5% and 47.5%, respectively. Furthermore, patients included in the VICTORIA study exhibited higher values of NT-proBNP (2816 pg/mL) compared to the PARADIGM-HF and DAPA-HF trials (1608 and 1437 pg/mL respectively) and a greater number of patients (41%) were in NYHA class III- IV compared to the 25% and 32% of the patients in the PARADIGM-HF and DAPA-HF trials, respectively [ 14 , 24 , 25 , 26 ].…”

“…The phase II SOCRATES-PRESERVED was a randomized, double-blind, placebo-controlled, dose-finding clinical trial in 477 patients with symptomatic chronic HF (NYHA functional classes II–IV) with preserved LVEF (defined as LVEF ≥ 45%) and a recent episode of worsening HF within 4 weeks, which required hospitalization or IV outpatient’s diuretic treatment, together with an elevation in natriuretic peptide levels at randomization (BNP ≥ 100 pg/mL or NT-proBNP levels ≥ 300 pg/mL if in sinus rhythm; BNP ≥ 200 pg/mL or NTproBNP ≥ 600 pg/mL if in atrial fibrillation) [ 26 , 30 ].…”

“…In this randomized study, there were three arms, two in which vericiguat was tried up to 15 mg or 10 mg and one who received placebo. After 24 weeks of treatment, there were no significant differences between the two groups concerning KCCQ scores or the six-minute walk test ( Table 4 ) [ 26 , 31 ].…”

“…To date, studies on vericiguat are limited by a short follow-up period and a small number of patients compared with other clinical trials in HF. In the PARADIGM-HF trial, 8442 patients were enrolled compared with 5050 patients enrolled in the VICTORIA trial and the median follow-up values were 27 months and 18 months in PARADIGM-HF and DAPA-HF trials, respectively, compared with 11 months in the VICTORIA trial [ 14 , 22 , 25 , 26 ]. We can, therefore, assume that a longer follow-up period might be useful to show additional data on absolute cardiovascular risk reduction beyond those already obtained.…”

“…Notably, compared with other pivotal studies conducted in chronic HF, the patients randomized in the VICTORIA trial appear less stable, with more severe conditions and with a higher risk of cardiovascular events, as evidenced by the elevated NT-proBNP levels (2888 pg/mL in VICTORIA, compared with 1608 and 1437 pg/mL in the PARADIGM-HF and DAPA-HF trials, respectively) and the presence of a higher number of patients in NYHA class III-IV (41% of patients in the VICTORIA trial compared with the 25% and 32% of the patients in the PARADIGM-HF and DAPA-HF trials, respectively) [ 14 , 22 , 25 , 26 ]. Future studies should be conducted with a better assessment of patient clinical severity, focusing on clinically stable subjects with advanced HF.…”