The Pharmaceutical Journal
Vol 270 No 7244 p506
12 April 2003

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American College of Cardiology congress (more)
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Nesiritide shortens hospital stay in heart failure

Nesiritide (Natrecor), a recombinant form of human B-type natriuretic peptide, significantly shortens the time patients with acutely decompensated heart failure stay in hospital, new data show. However, other results suggest that the drug may increase the risk of death compared with current treatments.

When administered intravenously, nesiritide causes dilation of arteries and veins without increasing heart rate. In a study of 130 patients consecutively discharged from the coronary care unit at Loma Linda University Medical Centre, California, 58 patients received nesiritide. Although the patients who received nesiritide had worse clinical symptoms on admission, they had shorter hospital stays (2.87 vs 3.79 days, respectively, P=0.002) (Journal of American College of Cardiology 2003;41[Suppl A]:161A).

Results of another study suggest that nesiritide might be a higher risk treatment for acutely decompensated heart failure than existing diuretic and vasodilating drugs. Researchers from St Luke's-Roosevelt Hospital, New York, calculated the risk of death at 30 days and six months using data from two published trials which used nesiritide.

Using crude mortality data, they found a trend towards higher mortality from using nesiritide in 735 patients followed for 30 days (7.2 vs 3.6 per cent, odds ratio 1.97, 95 per cent confidence interval 0.98-3.95, P=0.057). At six months, on an intention-to-treat basis, there was still a trend towards a higher risk of death for patients taking nesiritide (33 per cent for adjustable dosing, 22 per cent for fixed dosing and 20 for existing treatment, P=0.068).

The researchers comment: "Although effective at reducing symptoms compared with placebo, the modest acute clinical benefit compared with [existing therapy] (when including intravenous nitrogylcerin) coupled with possible long-term risk need to be considered prior to widespread clinical use." (Ibid, p161A).

The drug, developed by Scios Inc, is currently being submitted for marketing authorisation in Europe where it will be marketed by GlaxoSmithKline. Data were presented at the American College of Cardiology meeting in Chicago last week.

The Pharmaceutical Journal attended the American College of Cardiology congress courtesy of Merck/Schering-Plough Pharmaceuticals