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JACC Heart Fail. 2018 Feb;6(2):96-104. doi: 10.1016/j.jchf.2017.08.013. Epub 2017 Oct 11.

A Multicenter, Randomized, Double-Blind, Placebo-Controlled Trial of the Efficacy and Safety of the Oral Soluble Guanylate Cyclase Stimulator: The VICTORIA Trial.

Author information

1
Department of Medicine, Division of Cardiology, Canadian Virtual Coordinating Global Collaborative Cardiovascular Research Centre, University of Alberta, Edmonton, Alberta, Canada. Electronic address: paul.armstrong@ualberta.ca.
2
Bayer AG, Elberfeld, Germany.
3
Merck & Co. Inc., Rahway, New Jersey.
4
Duke Clinical Research Institute, Duke University, Durham, North Carolina.
5
Cardiology Division, Stony Brook University, Stony Brook, New York.
6
Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
7
National Heart Centre, Singapore, Singapore; Duke University-National University of Singapore Graduate Medical School, Singapore, Singapore.
8
Department of Cardiology, Centre for Heart Diseases, 4th Military Hospital, Wroclaw Medical University, Wroclaw, Poland; Department of Heart Diseases, Centre for Heart Diseases, 4th Military Hospital, Wroclaw Medical University, Wroclaw, Poland.
9
Department of Medicine, Division of Cardiology, Canadian Virtual Coordinating Global Collaborative Cardiovascular Research Centre, University of Alberta, Edmonton, Alberta, Canada.
10
Charité University Medicine, Campus Virchow Klinikum, Berlin, Germany.
11
Duke Clinical Research Institute, Duke University, Durham, North Carolina; German Heart Center, Berlin, Germany; Inova Heart and Vascular Institute, Falls Church, Virginia.

Abstract

This trial sought to evaluate whether vericiguat, a novel oral soluble guanylate cyclase (sGC) stimulator, was superior to placebo, on a background of standard of care, in increasing the time to the first occurrence of the composite endpoints of cardiovascular (CV) death and heart failure (HF) hospitalization in patients with HF with reduced ejection fraction (HFrEF). Deficiency in sGC-derived cyclic guanosine monophosphate (cGMP) causes both myocardial dysfunction and impaired endothelium-dependent vasomotor regulation that includes the myocardial microcirculation. Experimental studies have suggested multiple potential benefits of sGC stimulators including prevention, or even reversal, of left ventricular hypertrophy and fibrosis, as well as reduction of ventricular afterload through both systemic and pulmonary vasodilation. Hence, restoration of sufficient nitric oxide (NO)-sGC-cGMP signaling has been proposed as an important treatment target in HF. Vericiguat has been shown to directly stimulate sGC and enhance sGC sensitivity to endogenous NO. Available phase IIb data in HFrEF patients indicate vericiguat is safe and well-tolerated, and exploratory analyses indicate that it results in a dose-dependent, clinically significant reduction in N-terminal pro-B-type natriuretic peptide (NT-proBNP) at the highest tested dose. VICTORIA (Vericiguat Global Study in Subjects With Heart Failure With Reduced Ejection Fraction) is a randomized, placebo-controlled, parallel group, multicenter, double-blind, event-driven phase 3 trial of vericiguat in subjects with HFrEF. Approximately 4,872 subjects will be randomized to evaluate the efficacy and safety of vericiguat compared with placebo on a background of standard of care. After a screening phase of up to 30 days, eligible subjects will be treated until the required number of cardiovascular deaths is observed. The estimated median follow-up duration is approximately 18 months. All subjects will be followed until study completion to assess for the occurrence of endpoint events. VICTORIA will establish the efficacy and safety of vericiguat on cardiovascular death and HF hospitalization in patients with HFrEF. (A Randomized Parallel-Group, Placebo-Controlled, Double-Blind, Event-Driven, Multi-Center Pivotal Phase III Clinical Outcome Trial of Efficacy and Safety of the Oral sGC Stimulator Vericiguat in Subjects With Heart Failure With Reduced Ejection Fraction [HFrEF]-VerICiguaT Global Study in Subjects With Heart Failure With Reduced Ejection Fraction [VICTORIA]; NCT02861534).

KEYWORDS:

NO-sGC-cGMP; cardiovascular; heart failure; heart failure with reduced ejection fraction; pGC

PMID:
29032136
DOI:
10.1016/j.jchf.2017.08.013
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