Effect of carperitide on mortality and ANP levels in acute heart failure: A systematic review and meta-analysis

Acute heart failure (AHF) is a common and severe condition associated with high morbidity and mortality. Carperitide, a recombinant human atrial natriuretic peptide, has been widely used in Japan for managing AHF. However, its effectiveness in improving clinical outcomes such as mortality rates remains unclear, with conflicting evidence from studies. A systematic review and meta-analysis were conducted on studies comparing carperitide with placebo in AHF patients. Six studies including randomized and observational studies involving 30,665 patients were included, with primary outcomes being in-hospital mortality, heart failure-related mortality, and atrial natriuretic peptide (ANP) levels at 24 h. Statistical analysis was performed using the Mantel-Haenszel method for dichotomous outcomes and inverse variance for continuous outcomes. The meta-analysis found no significant difference in heart failure-related mortality (RR: 0.81; 95 % CI: 0.45–1.45) between carperitide and placebo groups. Following resolution of heterogeneity, a significantly higher in-hospital mortality was found in the carperitide group compared to placebo (RR: 1.16, 95 % CI: 1.07 to 1.27). However, ANP levels were significantly higher in the carperitide group (MD: 10.60; 95 % CI: 4.58–16.61) at 24 h. Carperitide increases ANP levels in patients with acute heart failure but does not reduce heart failure related mortality and is associated with higher in-hospital mortality. These findings suggest that its clinical benefits are limited, and safety concerns remain. Further high-quality trials are needed to better define its role, optimal patient selection, and long-term outcomes. • This systematic review and meta-analysis evaluated the effects of carperitide in 30,665 patients with acute heart failure (AHF) across six studies. • Carperitide did not significantly reduce heart failure–related mortality compared to placebo. • A significant increase in atrial natriuretic peptide (ANP) levels at 24 h was observed in the carperitide group. • Following resolution of heterogeneity, a significantly higher in-hospital mortality was found in the carperitide group compared to placebo • Carperitide may offer short-term symptom relief in selected patients with volume overload or low endogenous natriuretic peptide levels. • Further large-scale trials are needed to define optimal patient selection, dosing, and long-term safety.