Cook Jennifer C, Tran Richard H, Patterson J Herbert, Rodgers Jo E
Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC.
Division of Pharmacotherapy and Experimental Therapeutics, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC.
Am J Health Syst Pharm. 2016 Nov 1;73(21):1745-1754. doi: 10.2146/ajhp150635.
The pharmacology, clinical efficacy, and safety profiles of evolving therapies for the management of chronic heart failure (HF) and acute decompensated heart failure (ADHF) are described.
HF confers a significant financial burden despite the widespread use of traditional guideline-directed medical therapies such as angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, β-blockers, and aldosterone receptor antagonists, and the rates of HF-related mortality and hospitalization have remained unacceptably high. In response to a demand for novel pharmacologic agents, several therapeutic compounds have recently gained approval or are currently under review by the Food and Drug Administration. Sacubitril-valsartan has demonstrated benefit in reducing cardiovascular mortality and HF-related hospitalizations in clinical trials, while ivabradine and ferric carboxymaltose have proven efficacious in reducing HF-related hospitalizations. Lastly, the role of serelaxin in ADHF is currently under investigation in an ongoing Phase III study. While large, outcome-driven clinical trials are fundamental in informing the clinical application of these therapeutic agents, careful patient selection is imperative to ensuring similar outcomes postmarketing. In addition, optimization of current guideline-directed medical therapy remains essential as new therapies emerge and are incorporated into guideline recommendations. Additional therapeutic agents currently undergoing investigation include bucindolol hydrochloride, cimaglermin alfa, nitroxyl, omecamtiv mecarbil, TRV027, and ularitide. Clinical practitioners should remain abreast of emerging literature so that new therapeutic entities are optimally applied and positive patient outcomes are achieved.
Recently introduced agents for the treatment of patients with HF include sacubitril-valsartan, ivabradine, and ferric carboxymaltose. Additional agents worthy of attention include serelaxin and other therapies currently under investigation.
描述用于治疗慢性心力衰竭（HF）和急性失代偿性心力衰竭（ADHF）的不断发展的疗法的药理学、临床疗效和安全性概况。
尽管广泛使用了传统的指南指导药物疗法，如血管紧张素转换酶抑制剂、血管紧张素受体阻滞剂、β受体阻滞剂和醛固酮受体拮抗剂，但HF仍带来了巨大的经济负担，且HF相关的死亡率和住院率一直高得令人无法接受。为满足对新型药物的需求，几种治疗性化合物最近已获得批准或正在接受美国食品药品监督管理局的审查。沙库巴曲缬沙坦在临床试验中已证明对降低心血管死亡率和HF相关住院率有益，而伊伐布雷定和羧麦芽糖铁已被证明可有效降低HF相关住院率。最后，serelaxin在ADHF中的作用目前正在一项正在进行的III期研究中进行调查。虽然大规模的、以结果为导向的临床试验对于指导这些治疗药物的临床应用至关重要，但谨慎选择患者对于确保上市后取得相似结果至关重要。此外，随着新疗法的出现并纳入指南推荐，优化当前的指南指导药物治疗仍然至关重要。目前正在研究的其他治疗药物包括盐酸布辛多洛、西马格列明α、硝酰、奥米卡替麦卡比尔、TRV027和乌拉立肽。临床医生应及时了解最新文献，以便最佳地应用新的治疗药物并取得积极的患者治疗效果。
最近推出的用于治疗HF患者的药物包括沙库巴曲缬沙坦、伊伐布雷定和羧麦芽糖铁。其他值得关注的药物包括serelaxin和目前正在研究的其他疗法。
