Renal function and the effects of vericiguat in patients with worsening heart failure with reduced ejection fraction: insights from the VICTORIA (Vericiguat Global Study in Subjects with HFrEF) trial.

Abstract

AIMS:

Vericiguat reduced the primary composite outcome of cardiovascular death or heart failure (HF) hospitalization in patients with worsening HF with reduced ejection fraction (HFrEF) and a lower limit of baseline estimated glomerular filtration rate (eGFR) of 15 mL/min/1.73 m2 . We evaluated the relationship between the efficacy of vericiguat and baseline and subsequent changes in renal function.

METHODS AND RESULTS:

In VICTORIA, core laboratory serum creatinine was measured at baseline (n = 4956) and weeks 16, 32, and 48. Worsening renal function (WRF), defined as an increase ≥0.3 mg/dL in creatinine from baseline to week 16, was assessed via a Cox model with respect to subsequent primary events. Mean age was 69 years, 24% were female, and mean baseline eGFR was 61 mL/min/1.73 m2 . During 48 weeks of treatment, the trajectories in eGFR and creatinine with vericiguat were similar to placebo (P = 0.50 and 0.18). The beneficial effects of vericiguat on the primary outcome were not influenced by baseline eGFR (interaction P = 0.48). WRF occurred in 15% of patients and was associated with worse outcomes (adjusted hazard ratio 1.28, 95% confidence interval 1.11-1.47; P < 0.001), but the beneficial effects of vericiguat on the primary outcome were similar in patients with or without WRF (interaction P = 0.76).

CONCLUSION:

Renal function trajectories were similar between vericiguat- and placebo-treated patients and the beneficial effects of vericiguat on the primary outcome were consistent across the full range of eGFR and irrespective of WRF.

• Authors: Adriaan A Voors, Hillary Mulder, Eugene Reyes, Martin R Cowie, Johan Lassus, Adrian F Hernandez, Justin A Ezekowitz, Javed Butler, Christopher M O'Connor, Joerg Koglin, Carolyn S P Lam, Burkert Pieske, Lothar Roessig, Piotr Ponikowski, Kevin J Anstrom, Paul W Armstrong, VICTORIA Study Group
• Journal: European journal of heart failure (Eur J Heart Fail) Vol. 23 Issue 8 Pg. 1313-1321 (08 2021) ISSN: 1879-0844 [Electronic] England
• PMID: 33999486 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: © 2021 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.

Chemical References

• Heterocyclic Compounds, 2-Ring
• Pyrimidines
• vericiguat

Topics

• Aged
• Female
• Glomerular Filtration Rate
• Heart Failure (drug therapy, epidemiology)
• Heterocyclic Compounds, 2-Ring
• Humans
• Kidney (physiology)
• Male
• Pyrimidines
• Stroke Volume
• Treatment Outcome