Key result
Pecavaptan increases 7-day weight loss by ~0.5 kg versus placebo in acute heart failure.
Why the study?
Pecavaptan did not enhance weight loss by day 30 in hospitalized HF patients, but its short-term effects remained unclear.
Does the addition of pecavaptan to standard loop diuretic therapy improve early weight loss and congestion in patients hospitalized with acute heart failure and incomplete decongestion?
RCT (n=482)
Double-blind
Randomized
Yes
Does the addition of pecavaptan to standard loop diuretic therapy improve early weight loss and congestion in patients hospitalized with acute heart failure and incomplete decongestion?
In patients with acute heart failure and residual congestion, pecavaptan provides modest short-term improvements in early weight loss and pedal edema by day 7, but these effects are not sustained at 30 days.
Modest early weight loss without congestion score improvement does not support routine use in acute HF; leaves open dual V1a/V2 antagonism for further study.
BACKGROUND: Pecavaptan, a dual vasopressin V1a/V2-receptor antagonist, did not enhance weight loss by day 30 in hospitalized heart failure (HF) patients. However, its short-term effects remain unclear. OBJECTIVES: The objective of the study was to evaluate pecavaptan's effect on weight loss and congestion after 7 days. METHODS: AVANTI was a double-blind, randomized, placebo-controlled trial in patients hospitalized with HF and incomplete decongestion (n = 482). In part A, patients received pecavaptan (30 mg) (n = 242) or placebo (n = 240) as adjunctive therapy for 30 days. In this post hoc analysis, baseline-adjusted differences in weight change and a composite congestion score (CCS) at day 7 were calculated using analysis of covariance. Individual CCS component effects were assessed using baseline-adjusted ordinal regression at day 7. RESULTS: Patients had a median age of 70 years (IQR: 62.0-78.0) and 24% (118/482) were women. Pecavaptan resulted in greater weight loss vs placebo by day 7 (-1.43 kg vs -0.95 kg; difference -0.47 kg; 95% CI: -0.94 to -0.01; P = 0.044). Although the CCS was not significantly modified by pecavaptan at day 7 (P = 0.171), we observed a better resolution of pedal edema (adjusted OR: 0.63; 95% CI: 0.42-0.95; nominal P = 0.026) and reduced thoracic fluid content (difference: -1.43%; 95% CI: -2.57 to -0.28; nominal P = 0.015) at day 7. These effects were limited and no longer significant by day 30. An increase in plasma osmolality and serum sodium concentration by pecavaptan was observed at day 7 and day 30 (both P < 0.01). CONCLUSIONS: In patients hospitalized for acute HF with residual congestion, pecavaptan showed modest signals of early decongestion, without durable benefit at 30 days. These post hoc findings require prospective confirmation. (A Trial to Study BAY1753011 in Patients With Congestive Heart Failure [AVANTI]; NCT03901729).
No takes yet. Share an insight, caveat, or question.
Ceelen et al. (2026) conducted an RCT in Acute heart failure with incomplete decongestion (n=482). Pecavaptan vs. Placebo was evaluated on Weight change from baseline to day 7 (Mean difference -0.47 kg, 95% CI -0.94 to -0.01, p=0.044). Pecavaptan produced greater short-term weight loss versus placebo by day 7 (difference -0.47 kg) in acute heart failure patients, though it did not significantly improve composite congestion scores.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: