The Pharmaceutical Journal
Vol 268 No 7191 p419-425
30 March 2002

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JAMA (jama.ama-assn.org)

Nesiritide but not milrinone useful in heart failure

Results from two studies this week shed new light on the treatment of acute heart failure. One found that nesiritide (a recombinant human brain natriuretic peptide) might be a useful adjunct to therapy and the other that milrinone (Primacor) is not useful.

In the first study, investigators from the VMAC (vasodilator in the management of acute congestive heart failure) study compared use of nesiritide, glyceryl trinitrate (GTN) and placebo added to standard therapy in 489 patients. After three and 24 hours, the mean decrease in pulmonary capillary wedge pressure was significantly greater in the nesiritide group compared with that in the GTN and placebo groups. At three hours, nesiritide also led to an improvement in dyspnoea compared with placebo but not with GTN. The authors conclude: "When added to standard care ... nesiritide improves haemodynamic function and some self-reported symptoms more effectively than intravenous [GTN] or placebo." (JAMA 2002;287:1531)

In the second study, Dr Michael Cuffe, Duke Clinical Research Institute, Durham, United States, and colleagues compared the effectiveness of milrinone with placebo in 951 patients (ibid, p1541). They found that treatment with milrinone did not reduce the number of days in hospital for cardiovascular causes within 60 days compared with placebo. No difference in in-hospital mortality or 60-day mortality was found. In addition, treatment failures caused by adverse events were more common in the first 48 hours in milrinone-treated patients. The authors conclude: "Our results do not support the routine use of milrinone in patients hospitalised with exacerbations of chronic heart failure."