New developments in the pharmacological treatment of chronic heart failure.
In recent years, rapid growth in the understanding of the pathophysiology of chronic heart failure has allowed for insights into many potential new therapeutic strategies. Yet until now, despite sound biological basis for efficacy and success in early-Phase studies, novel agents have not stood up to the scrutiny of late-Phase clinical trials. Indeed, remarkably negative results have been observed for vasopeptidase inhibitors, endothelin receptor antagonists and agents which block immune activation. However, efficacy data from other novel agents are still awaited, including the selective aldosterone receptor antagonist eplerenone, arginine vasopressin inhibitors, erythropoietin and hydroxy-methyl-glutaryl coenzyme A reductase inhibitors. Other classes of drugs which may enter clinical development include cardiac metabolic agents, matrix metalloproteinase inhibitors and advanced glycation end product antagonists. That the mortality and morbidity of patients with chronic heart failure remain unacceptably high makes the ongoing commitment to exploration of new drug therapies for the condition critical.
Krum
Henry
H
Department of Medicine, Monash University Central and Eastern Clinical School, Alfred Hospital, Melbourne, Victoria 3004, Australia. henry.krum@med.monash.edu.au
Liew
Danny
D
D001127:Arginine Vasopressin / Q000037:antagonists & inhibitors; D002317:Cardiovascular Agents / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D065128:Endothelin Receptor Antagonists; D004921:Erythropoietin / Q000037:antagonists & inhibitors; D017127:Glycation End Products, Advanced / Q000037:antagonists & inhibitors; D006333:Heart Failure / Q000188:drug therapy* / Q000276:immunology / Q000378:metabolism; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D061965:Matrix Metalloproteinase Inhibitors; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use
D002317:Cardiovascular Agents; D065128:Endothelin Receptor Antagonists; D017127:Glycation End Products, Advanced; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D007166:Immunosuppressive Agents; D061965:Matrix Metalloproteinase Inhibitors; D000451:Mineralocorticoid Receptor Antagonists; D004921:Erythropoietin; D001127:Arginine Vasopressin