Vericiguat reduced cardiovascular death or heart failure hospitalization compared with placebo in HFrEF patients with NT-proBNP levels up to 8,000 pg/ml (HR 0.85; 95% CI 0.76-0.95).
RCT (n=4,805)
Does vericiguat reduce cardiovascular death or heart failure hospitalization in patients with HFrEF across different baseline NT-proBNP levels?
Vericiguat reduces cardiovascular death or heart failure hospitalization in HFrEF patients with NT-proBNP levels up to 8,000 pg/ml, but the benefit is attenuated at higher levels.
Effect estimate: HR 0.85 (95% CI 0.76-0.95)
p-value: p=0.002 for interaction
OBJECTIVES: The purpose of this study was to examine the treatment effect of vericiguat in relation to N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels at randomization. BACKGROUND: Vericiguat compared with placebo reduced the primary outcome of cardiovascular death (CVD) or heart failure hospitalization (HFH) in patients with HF with reduced ejection fraction (HFrEF) in the VICTORIA (A Study of Vericiguat in Participants With Heart Failure With Reduced Ejection Fraction) trial. Because an interaction existed between treatment and the primary outcome according to pre-specified quartiles of NT-proBNP at randomization, we examined this further. METHODS: This study evaluated the NT-proBNP relationship with the primary outcome in 4,805 of 5,050 patients as a risk-adjusted, log-transformed continuous variable. Hazard ratios (HRs) and 95% confidence intervals (CIs) are presented. RESULTS: transformation, p for interaction = 0.002). A significant association between treatment effects existed in patients with levels 8,000 pg/ml (n = 672), the HR was 1.16 (95% CI: 0.94 to 1.41) for the primary outcome. CONCLUSIONS: A reduction in the primary composite endpoint and its CVD and HFH components was observed in patients on vericiguat compared with subjects on placebo with NT-proBNP levels up to 8,000 pg/ml. This provided new insight into the benefit observed in high-risk patients with worsening HFrEF. (A Study of Vericiguat in Participants With Heart Failure With Reduced Ejection Fraction HFrEF MK-1242-001 VICTORIA; NCT02861534).
Ezekowitz et al. (Wed,) conducted a rct in Heart failure with reduced ejection fraction (HFrEF) (n=4,805). Vericiguat vs. Placebo was evaluated on Cardiovascular death (CVD) or heart failure hospitalization (HFH) (HR 0.85, 95% CI 0.76-0.95, p=0.002 for interaction). Vericiguat reduced cardiovascular death or heart failure hospitalization compared with placebo in HFrEF patients with NT-proBNP levels up to 8,000 pg/ml (HR 0.85; 95% CI 0.76-0.95).