Rationale and design of the treatment of hyponatremia based on lixivaptan in NYHA class III/IV cardiac patient evaluation (THE BALANCE) study.
Hyponatremia is a common electrolyte disorder in patients with heart failure (HF) associated with cognitive dysfunction and increased mortality and rehospitalization rates. Loop diuretics worsen renal function, produce neurohormonal activation, and induce electrolyte imbalances. Lixivaptan is a selective, oral vasopressin V(2) -receptor antagonist that improves hyponatremia by promoting electrolyte-free aquaresis without significant side effects. The Treatment of Hyponatremia Based on Lixivaptan in NYHA Class III/IV Cardiac Patient Evaluation (BALANCE) study is a randomized, double-blind, placebo-controlled, phase 3 trial designed to evaluate the effects of lixivaptan on serum sodium in patients hospitalized with worsening heart failure (target N= 650), signs of congestion and serum sodium concentrations <135 mEq/L. Other endpoints include assessment of dyspnea, body weight, cognitive function, and days of hospital-free survival. Patients are randomized 1:1 to lixivaptan or matching placebo for 60 days, with a 30-day safety follow-up. Doses of lixivaptan or placebo are adjusted based on serum sodium and volume status. Lixivaptan was shown to increase serum sodium and reduce body weight, without renal dysfunction or hypokalemia. BALANCE seeks to address unmet questions regarding the use of vasopressin antagonists including their effects on cognitive function and clinical outcomes in patients with hyponatremia and worsening heart failure.
Division of Cardiovascular Medicine, The Ohio State University Heart Center, Columbus, USA. william.abraham@osumc.edu
William T
WT
Abraham
Juan M
JM
Aranda
John P
JP
Boehmer
Uri
U
Elkayam
Edward M
EM
Gilbert
Stephen S
SS
Gottlieb
Gerd
G
Hasenfuss
Marrick
M
Kukin
Brian D
BD
Lowes
John B
JB
O'Connell
Luigi
L
Tavazzi
Arthur M
AM
Feldman
Barry
B
Ticho
Cesare
C
Orlandi
D001549:Benzamides / Q000627:therapeutic use*; D023381:Endpoint Determination; D006801:Humans; D007010:Hyponatremia / Q000188:drug therapy*; D011758:Pyrroles / Q000627:therapeutic use*; D001569:Benzodiazepines
D001549:Benzamides; D011758:Pyrroles; C409452:lixivaptan; D001569:Benzodiazepines