a Department of Pharmacology and Toxicology, School of Medicine , Universidad Complutense, CIBERCV , Madrid , Spain.
Expert Opin Investig Drugs. 2019 Jan;28(1):51-71. doi: 10.1080/13543784.2019.1551357. Epub 2018 Dec 7.
Heart failure (HF) represents a major health problem because of its high prevalence, high rates of hospitalizations, and mortality and significant healthcare costs. HF comprises a heterogeneous group of syndromes with different pathophysiology, clinical presentations, and response to therapy. Basic research has identified multiple putative therapeutic targets involved in the pathogenesis of HF and many promising drugs are under development.
This review summarizes the main drugs currently in preclinical and clinical development for HF treatment. Drugs were identified by search of MEDLINE and PubMed and trials from registries (clinicaltrials.gov, clinicaltrialsregister.eu, pubmed.gov) from 2010.
Despite significant advances in the pharmacological treatment of HF with reduced ejection fraction, no treatment has yet convincingly shown to improve outcomes in patients with HF with preserved ejection fraction and acute HF. Many promising drugs emerged in preclinical models and small phase 2 trials, but with a few exceptions, they fail to meet the primary endpoints in larger adequately powered phase 3 trials. Which new drugs will prove valuable remains uncertain. Improving clinical outcomes, delaying or preventing HF worsening and reducing hospital admissions should be prioritized in future drug development programs.
心力衰竭（HF）是一个主要的健康问题，因为它的高患病率、高住院率、高死亡率和高医疗成本。HF 由一组具有不同病理生理学、临床表现和对治疗反应的综合征组成。基础研究已经确定了多个潜在的治疗靶点，涉及 HF 的发病机制，许多有前途的药物正在开发中。
本文综述了目前处于 HF 治疗临床前和临床开发阶段的主要药物。通过检索 MEDLINE 和 PubMed 以及注册处（clinicaltrials.gov、clinicaltrialsregister.eu、pubmed.gov）的试验，从 2010 年开始。
尽管射血分数降低的 HF 的药物治疗取得了显著进展，但仍没有一种治疗方法能够令人信服地改善射血分数保留的 HF 和急性 HF 患者的结局。许多有前途的药物在临床前模型和小型 2 期试验中出现，但除了少数例外，它们未能在更大的、充分有效的 3 期试验中达到主要终点。哪些新药将被证明是有价值的仍然不确定。在未来的药物开发计划中，应优先考虑改善临床结局、延缓或预防 HF 恶化以及减少住院。
