The Vasopressin V2 Receptor Antagonists: The Vaptans

In this mini-review the pathogenesis and pathophysiology of the new vasopressin antagonists are discussed. Indications, appropriate and inappropriate use of the vaptans are evaluated. The efficacy and safety of the vaptans has been well established. Costs are high and the vaptans are not cost-effective in the long-term treatment of autosomal dominant polycystic kidney disease (APDKD) with a cost of U.S. $744.100 per equally adjusted life year (QALY) gained compared to standard care. This is seven times the standard willingness to pay treshold. A secondary analysis of the SALT trials reached no significant beneficial cost-benefit analysis for tolvaptan in the treatment of patients with the syndrome of ïnappropriate secretion of antiduretc hormone (SIADH). U.S. and European expert panels released different treatment guidelines. Solid endpoint studies on the increased mortality of hyponatremia are lacking.