Nesiritide: a reappraisal of efficacy and safety

Abstract

The treatment of acute decompensated heart failure (ADHF) remains a therapeutic challenge. Nesiritide was approved by the FDA in 2001 for the treatment of patients with ADHF who have dyspnea at rest or with minimal exertion. Although widely adopted for the treatment of ADHF due to its ability to decrease ventricular filling pressures and to provide mild symptomatic benefit, recent analyses have suggested that nesiritide worsens renal function and increases mortality. Although some discount these analyses that demonstrate the potential dangers of nesiritide, others have stated that its use at the present time must be weighed against the possibility of worse outcomes. A large outcomes trial in patients with ADHF would help clarify the role of nesiritide.

Keywords::

• congestive heart failure
• natriuretic
• peptide
• nesiritide
• renal insufficiency

Acknowledgements

The authors wish to note the helpful comments by the peer reviewers and the representative from Scios who reviewed the manuscript.

Conflicts of interest

JR Teerlink formerly received speaking honoraria from Scios. In addition, he has been a consultant to the following companies: Abbott, Actelion, Cytokinetics, Geron, Myogen, NovaCardia. Protein Design Labs, Sigma-Tau and Wyeth. He has received research support from: Abbott, Actelion, Bristol Meyers-Squibb, Cytokinetics, National Institute of Health, NovaCardia, Protein Design Labs, and the Department of Veterans Affairs.

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