Farmacja Polska (Dec 2021)
The soluble guanylate cyclase stimulator named vericiguat as an innovative heart failure therapy representative
Abstract
A noticeable trend towards greater heart failure morbidity is observed in Poland as well as in the whole world. The percentage of people living with the above mentioned disease is growing mostly due to the process of ageing of populations. As per the epidemiological data from 2017 report 70 million people suffer from heart failure in the world and seven of ten lives in the European Union. Those frightening data put pressure on the scientists to continuously search for the new therapeutic interventions and pharmacological innovations to reduce morbidity. The updated Guidelines for diagnosis and treatment of acute and chronic heart failure were published by the European Cardiological Society on 27-th of August 2021. The new concept of algorithm of heart failure treatment was included in them. The new drug class is now recommended along with beta-blockers, angiotensin converting enzyme inhibitors or angiotensin receptor-nephrilysin inhibitor and mineralocorticoid receptor antagonists- inhibitors of the second sodium-glucose cotransporter with its two representatives, dapagliflozin and empagliflozin. In addition, a new promising molecule, vericiguat, was included in 2021 heart failure Guidelines. This stimulator of soluble guanylate cyclase is not the highest class recommendation. It is prescribed for the patient suffering from heart failure with a reduced ejection fraction and symptoms in NYHA II, III, IV class and for the patients with recent disease exacerbation despite regular therapy with beta blocker, angiotensin converting enzyme inhibitor or angiotensin receptor-nephrilysin inhibitor and mineralocorticoid receptor antagonist. Results of the clinical trial VICTORIA proved that vericiguat contributes to the reduced cardio-vascular death risk in patients recently hospitalized as a consequence of heart failure exacerbation or those who required intravenous diuretic treatment in an outpatient clinic. A full potential of the molecule is still to be elucidated taking into account the results of present and future clinical trials. Data from VICTORIA trial give a hope for the future development of heart failure pharmacotherapy. The utilization of the oral soluble stimulator of guanylate cyclase restores efficient functionality of NO-sGC-cGMP signal pathway. This fact together with neurohormonal blockade and afterload reduction make the achievement of the goal of superior heart failure survival closer. Drugs that induce neurohormonal blockade are very effective in slowing progression of the disease in stable patients whereas vericiguat may be the drug of choice in high risk patients with the history of recent or recurrent hospitalization despite guideline directed therapy. Keywords: heart failure, vericiguat, stimulator of soluble guanylate cyclase, nitric oxide-soluble guanylate cyclase-cyclic guanosine monophosphate pathway
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