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Erschienen in: Cardiovascular Drugs and Therapy 1/2011

01.12.2011

Efficacy and Safety of Tolvaptan in Heart Failure Patients with Volume Overload Despite the Standard Treatment with Conventional Diuretics: A Phase III, Randomized, Double-blind, Placebo-controlled Study (QUEST Study)

verfasst von: Masunori Matsuzaki, Masatsugu Hori, Tohru Izumi, Masatake Fukunami, for the Tolvaptan Investigators

Erschienen in: Cardiovascular Drugs and Therapy | Sonderheft 1/2011

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Abstract

Purpose

Diuretics are recommended to treat volume overload with heart failure (HF), however, they may cause serum electrolyte imbalance, limiting their use. Moreover, patients with advanced HF could poorly respond to these diuretics. In this study, we evaluated the efficacy and safety of Tolvaptan, a competitive vasopressin V2-receptor antagonist developed as a new drug to treat volume overload in HF patients.

Methods

A phase III, multicenter, randomized, double-blind, placebo-controlled parallel study was performed to assess the efficacy and safety of tolvaptan in treating HF patients with volume overload despite the use of conventional diuretics. One hundred and ten patients were randomly assigned to receive either placebo or 15 mg/day tolvaptan for 7 consecutive days.

Results

Compared with placebo, tolvaptan administered for 7 days significantly reduced body weight and improved symptoms associated with volume overload. The safety profile of tolvaptan was considered acceptable for clinical use with minimal adverse effects.

Conclusion

Tolvaptan reduced volume overload and improved congestive symptoms associated with HF by a potent water diuresis (aquaresis).
Literatur
2.
Zurück zum Zitat Nohria A, Tsang SW, Fang JC, et al. Clinical assessment identifies hemodynamic profiles that predict outcomes in patients admitted with heart failure. J Am Coll Cardiol. 2003;41:1797–804.PubMedCrossRef Nohria A, Tsang SW, Fang JC, et al. Clinical assessment identifies hemodynamic profiles that predict outcomes in patients admitted with heart failure. J Am Coll Cardiol. 2003;41:1797–804.PubMedCrossRef
3.
Zurück zum Zitat Hunt SA, Abraham WT, Chin MH, et al. ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure). Circulation. 2005;112:e154–235.PubMedCrossRef Hunt SA, Abraham WT, Chin MH, et al. ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure). Circulation. 2005;112:e154–235.PubMedCrossRef
4.
Zurück zum Zitat Gupta S, Neyses L. Diuretic usage in heart failure: a continuing conundrum in 2005. Eur Heart J. 2005;26:644–9.PubMedCrossRef Gupta S, Neyses L. Diuretic usage in heart failure: a continuing conundrum in 2005. Eur Heart J. 2005;26:644–9.PubMedCrossRef
5.
Zurück zum Zitat Raftery EB. Haemodynamic effects of diuretics in heart failure. Br Heart J. 1994;72(suppl):S44–7.PubMedCrossRef Raftery EB. Haemodynamic effects of diuretics in heart failure. Br Heart J. 1994;72(suppl):S44–7.PubMedCrossRef
6.
Zurück zum Zitat Multiple Risk Factor Intervention Trial Group. Baseline rest electrocardiographic abnormalities, antihypertensive treatment, and mortality in the Multiple Risk Factor Intervention Trial. Am J Cardiol. 1985;55:1–15.CrossRef Multiple Risk Factor Intervention Trial Group. Baseline rest electrocardiographic abnormalities, antihypertensive treatment, and mortality in the Multiple Risk Factor Intervention Trial. Am J Cardiol. 1985;55:1–15.CrossRef
7.
Zurück zum Zitat Cooper HA, Dries DL, Davis CE, Shen YL, Domanski MJ. Diuretics and risk of arrhythmic death in patients with left ventricular dysfunction. Circulation. 1999;100:1311–5.PubMed Cooper HA, Dries DL, Davis CE, Shen YL, Domanski MJ. Diuretics and risk of arrhythmic death in patients with left ventricular dysfunction. Circulation. 1999;100:1311–5.PubMed
8.
Zurück zum Zitat Yamamura Y, Nakamura S, Itoh S, et al. OPC-41061, a highly potent human vasopressin V2-receptor antagonist: pharmacological profile and aquaretic effect by single and multiple oral dosing in rats. J Pharmacol Exp Ther. 1998;287:860–7.PubMed Yamamura Y, Nakamura S, Itoh S, et al. OPC-41061, a highly potent human vasopressin V2-receptor antagonist: pharmacological profile and aquaretic effect by single and multiple oral dosing in rats. J Pharmacol Exp Ther. 1998;287:860–7.PubMed
9.
Zurück zum Zitat Gheorghiade M, Niazi I, Ouyang J, et al. Vasopressin V2-receptor blockade with tolvaptan in patients with chronic heart failure: results from a double-blind, randomized trial. Circulation. 2003;107:2690–6.PubMedCrossRef Gheorghiade M, Niazi I, Ouyang J, et al. Vasopressin V2-receptor blockade with tolvaptan in patients with chronic heart failure: results from a double-blind, randomized trial. Circulation. 2003;107:2690–6.PubMedCrossRef
10.
Zurück zum Zitat Costello-Boerrigter LC, Smith WB, Boerrigter G, et al. Vasopressin-2-receptor antagonism augments water excretion without changes in renal hemodynamics or sodium and potassium excretion in human heart failure. Am J Physiol Ren Physiol. 2006;290:F273–8.CrossRef Costello-Boerrigter LC, Smith WB, Boerrigter G, et al. Vasopressin-2-receptor antagonism augments water excretion without changes in renal hemodynamics or sodium and potassium excretion in human heart failure. Am J Physiol Ren Physiol. 2006;290:F273–8.CrossRef
11.
Zurück zum Zitat Matsuzaki M, Masatsugu H, Izumi T, Asanoi H, Tsutamoto T, Tolvaptan Investigators. Effects of tolvaptan on volume overload in Japanese patients with heart failure: results of a phase II, multicenter, randomized, double-blind, placebo-controlled, parallel-group study. Cardiovasc Drugs Ther. 2011; e-pub ahead of print. Matsuzaki M, Masatsugu H, Izumi T, Asanoi H, Tsutamoto T, Tolvaptan Investigators. Effects of tolvaptan on volume overload in Japanese patients with heart failure: results of a phase II, multicenter, randomized, double-blind, placebo-controlled, parallel-group study. Cardiovasc Drugs Ther. 2011; e-pub ahead of print.
12.
Zurück zum Zitat Marsh JD, Smith TW. Piretanide: a loop-active diuretic. Pharmacology, therapeutic efficacy and adverse effects. Pharmacotherapy. 1984;4:170–80.PubMed Marsh JD, Smith TW. Piretanide: a loop-active diuretic. Pharmacology, therapeutic efficacy and adverse effects. Pharmacotherapy. 1984;4:170–80.PubMed
13.
Zurück zum Zitat Schrier RW, Gross P, Gheorghiade M, et al. Tolvaptan, a selective oral vasopressin V2-receptor antagonist, for hyponatremia. N Engl J Med. 2006;355:2099–112.PubMedCrossRef Schrier RW, Gross P, Gheorghiade M, et al. Tolvaptan, a selective oral vasopressin V2-receptor antagonist, for hyponatremia. N Engl J Med. 2006;355:2099–112.PubMedCrossRef
14.
Zurück zum Zitat Sterns RH, Cappuccio JD, Silver SM, Cohen EP. Neurologic sequelae after treatment of severe hyponatremia: a multicenter perspective. J Am Soc Nephrol. 1994;4:1522–30.PubMed Sterns RH, Cappuccio JD, Silver SM, Cohen EP. Neurologic sequelae after treatment of severe hyponatremia: a multicenter perspective. J Am Soc Nephrol. 1994;4:1522–30.PubMed
15.
Zurück zum Zitat Konstam MA, Gheorghiade M, Burnett Jr JC, et al. Effects of oral tolvaptan in patients hospitalized for worsening heart failure: the EVEREST outcome trial. JAMA. 2007;297:1319–31.PubMedCrossRef Konstam MA, Gheorghiade M, Burnett Jr JC, et al. Effects of oral tolvaptan in patients hospitalized for worsening heart failure: the EVEREST outcome trial. JAMA. 2007;297:1319–31.PubMedCrossRef
16.
Zurück zum Zitat Gheorghiade M, Konstam MA, Burnett Jr JC, et al. Short-term clinical effects of tolvaptan, an oral vasopressin antagonist, in patients hospitalized for heart failure: the EVEREST clinical status trials. JAMA. 2007;297:1332–43.PubMedCrossRef Gheorghiade M, Konstam MA, Burnett Jr JC, et al. Short-term clinical effects of tolvaptan, an oral vasopressin antagonist, in patients hospitalized for heart failure: the EVEREST clinical status trials. JAMA. 2007;297:1332–43.PubMedCrossRef
17.
Zurück zum Zitat Fukunami M, Matsuzaki M, Hori M, et al. Efficacy and Safety of Tolvaptan in Heart Failure Patients with Sustained Volume Overload Despite the Use of Conventional Diuretics: A Phase III Open-label Study. Cardiovasc Drugs Ther. 2011; e-pub ahead of print. Fukunami M, Matsuzaki M, Hori M, et al. Efficacy and Safety of Tolvaptan in Heart Failure Patients with Sustained Volume Overload Despite the Use of Conventional Diuretics: A Phase III Open-label Study. Cardiovasc Drugs Ther. 2011; e-pub ahead of print.
18.
Zurück zum Zitat Inomata T, Izumi T, Matsuzaki M, et al. Phase III Clinical Pharmacology Study of Tolvaptan. Cardiovasc Drugs Ther. 2011; e-pub ahead of print. Inomata T, Izumi T, Matsuzaki M, et al. Phase III Clinical Pharmacology Study of Tolvaptan. Cardiovasc Drugs Ther. 2011; e-pub ahead of print.
19.
Zurück zum Zitat Udelson JE, McGrew FA, Flores E, et al. Multicenter, randomized, double-blind, placebo-controlled study on the effect of oral tolvaptan on left ventricular dilation and function in patients with heart failure and systolic dysfunction. J Am Coll Cardiol. 2007;49:2151–9.PubMedCrossRef Udelson JE, McGrew FA, Flores E, et al. Multicenter, randomized, double-blind, placebo-controlled study on the effect of oral tolvaptan on left ventricular dilation and function in patients with heart failure and systolic dysfunction. J Am Coll Cardiol. 2007;49:2151–9.PubMedCrossRef
20.
Zurück zum Zitat Takaku F, Ogata E, Kurokawa K, Yazaki Y. New clinical internal medicine. 9th ed. Tokyo: Igaku-shoin Ltd.; 2009. Takaku F, Ogata E, Kurokawa K, Yazaki Y. New clinical internal medicine. 9th ed. Tokyo: Igaku-shoin Ltd.; 2009.
Metadaten
Titel
Efficacy and Safety of Tolvaptan in Heart Failure Patients with Volume Overload Despite the Standard Treatment with Conventional Diuretics: A Phase III, Randomized, Double-blind, Placebo-controlled Study (QUEST Study)
verfasst von
Masunori Matsuzaki
Masatsugu Hori
Tohru Izumi
Masatake Fukunami
for the Tolvaptan Investigators
Publikationsdatum
01.12.2011
Verlag
Springer US
Erschienen in
Cardiovascular Drugs and Therapy / Ausgabe Sonderheft 1/2011
Print ISSN: 0920-3206
Elektronische ISSN: 1573-7241
DOI
https://doi.org/10.1007/s10557-011-6304-x

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