Nesiritide: trials and tribulations.
Standard therapy for acute decompensated heart failure, a major health problem, consists of intravenous diuretics, vasodilators, and positive inotropic agents. Nesiritide, a recombinant form of human B-type natriuretic peptide, is the only drug specifically approved for this indication. Recent meta-analyses have reported an increased risk of worsening renal function and 30-day mortality with nesiritide administration. These data understandably require physicians to carefully reevaluate their current use of nesiritide in patients with acute decompensated heart failure. In performing this reevaluation, it is important to consider our understanding of the underlying disease state, the limitations and results of these meta-analyses, and new data that provide additional insight into the possible risks and benefits associated with nesiritide therapy. Until additional therapeutic trials are conducted, therapeutic choices must be based on symptomatic and hemodynamic improvement and limited, imperfect available data, which may continue to support the use of nesiritide for its established indication.
Arora
Rohit R
RR
Department of Medicine, The Chicago Medical School, Chicago, Illinois, USA. rohit.arora@va.gov
D000208:Acute Disease; D003404:Creatinine / Q000097:blood; D003657:Decision Making; D006333:Heart Failure / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D015201:Meta-Analysis as Topic; D045283:Natriuretic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D020097:Natriuretic Peptide, Brain / Q000009:adverse effects / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D051437:Renal Insufficiency / Q000097:blood / Q000139:chemically induced / Q000453:epidemiology; D012107:Research Design; D018570:Risk Assessment; D012307:Risk Factors
D045283:Natriuretic Agents; D020097:Natriuretic Peptide, Brain; D003404:Creatinine