Short-Term Therapies for Treatment of Acute and Advanced Heart Failure-Why so Few Drugs Available in Clinical Use, Why Even Fewer in the Pipeline?

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Pollesello , P , Ben Gal , T , Bettex , D , Cerny , V , Comin-Colet , J , Eremenko , A A , Farmakis , D , Fedele , F , Fonseca , C , Harjola , V-P , Herpain , A , Heringlake , M , Heunks , L , Husebye , T , Ivancan , V , Karason , K , Kaul , S , Kubica , J , Mebazaa , A , Molgaard , H , Parissis , J , Parkhomenko , A , Poder , P , Polzl , G , Vrtovec , B , Yilmaz , M B & Papp , Z 2019 , ' Short-Term Therapies for Treatment of Acute and Advanced Heart Failure-Why so Few Drugs Available in Clinical Use, Why Even Fewer in the Pipeline? ' , Journal of clinical medicine , vol. 8 , no. 11 , 1834 . https://doi.org/10.3390/jcm8111834

Title: Short-Term Therapies for Treatment of Acute and Advanced Heart Failure-Why so Few Drugs Available in Clinical Use, Why Even Fewer in the Pipeline?
Author: Pollesello, Piero; Ben Gal, Tuvia; Bettex, Dominique; Cerny, Vladimir; Comin-Colet, Josep; Eremenko, Alexandr A.; Farmakis, Dimitrios; Fedele, Francesco; Fonseca, Candida; Harjola, Veli-Pekka; Herpain, Antoine; Heringlake, Matthias; Heunks, Leo; Husebye, Trygve; Ivancan, Visnja; Karason, Kristian; Kaul, Sundeep; Kubica, Jacek; Mebazaa, Alexandre; Molgaard, Henning; Parissis, John; Parkhomenko, Alexander; Poder, Pentti; Polzl, Gerhard; Vrtovec, Bojan; Yilmaz, Mehmet B.; Papp, Zoltan
Contributor: University of Helsinki, HUS Emergency Medicine and Services
Date: 2019-11
Language: eng
Number of pages: 19
Belongs to series: Journal of clinical medicine
ISSN: 2077-0383
URI: http://hdl.handle.net/10138/310418
Abstract: Both acute and advanced heart failure are an increasing threat in term of survival, quality of life and socio-economical burdens. Paradoxically, the use of successful treatments for chronic heart failure can prolong life but-per definition-causes the rise in age of patients experiencing acute decompensations, since nothing at the moment helps avoiding an acute or final stage in the elderly population. To complicate the picture, acute heart failure syndromes are a collection of symptoms, signs and markers, with different aetiologies and different courses, also due to overlapping morbidities and to the plethora of chronic medications. The palette of cardio- and vasoactive drugs used in the hospitalization phase to stabilize the patient's hemodynamic is scarce and even scarcer is the evidence for the agents commonly used in the practice (e.g., catecholamines). The pipeline in this field is poor and the clinical development chronically unsuccessful. Recent set backs in expected clinical trials for new agents in acute heart failure (AHF) (omecamtiv, serelaxine, ularitide) left a field desolately empty, where only few drugs have been approved for clinical use, for example, levosimendan and nesiritide. In this consensus opinion paper, experts from 26 European countries (Austria, Belgium, Croatia, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Israel, Italy, The Netherlands, Norway, Poland, Portugal, Russia, Slovenia, Spain, Sweden, Switzerland, Turkey, U.K. and Ukraine) analyse the situation in details also by help of artificial intelligence applied to bibliographic searches, try to distil some lesson-learned to avoid that future projects would make the same mistakes as in the past and recommend how to lead a successful development project in this field in dire need of new agents.
Subject: acute heart failure
advanced heart failure
short-term hemodynamic therapy
regulatory clinical trials
clinical development
levosimendan
INTERMITTENT LEVOSIMENDAN TREATMENT
OMECAMTIV MECARBIL
VS. DOBUTAMINE
RELAX-AHF
TRIAL
CONTRACTILITY
SERELAXIN
MIDRANGE
DESIGN
AGENT
3121 General medicine, internal medicine and other clinical medicine
3126 Surgery, anesthesiology, intensive care, radiology
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