Beata Jacuś, Mirosława Kowalkowska, Paweł Miękus, Grzegorz Grześk

The soluble guanylate cyclase stimulator named vericiguat as an innovative heart failure therapy representative
2021-12-17

A noticeable trend towards greater heart failure morbidity is observed in Poland as well as in the whole world. The percentage of people living with the above‑mentioned disease is growing mostly due to the process of aging of populations. As per the epidemiological data from the 2017 report 70 million people suffer from heart failure in the world and seven of ten live in the European Union.

Those frightening data put pressure on scientists to continuously search for new therapeutic interventions and pharmacological innovations to reduce morbidity.

The updated Guidelines for diagnosis and treatment of acute and chronic heart failure were published by the European Cardiological Society on the 27th of August 2021. The new concept of an algorithm of heart failure treatment was included in them.

The new drug class is now recommended along with beta-blockers, angiotensin‑converting enzyme inhibitors or neprilysin receptor-nephrilysin inhibitor and mineralocorticoid receptor antagonists: inhibitors of the second sodium-glucose cotransporter with its two representatives, dapagliflozin and empagliflozin.

In addition, a new promising molecule, vericiguat, was included in the 2021 heart failure Guidelines.

This stimulator of soluble guanylate cyclase is not the highest class recommendation. It is prescribed for the patient suffering from heart failure with a reduced ejection fraction and symptoms in NYHA II, III, IV class and for the patients with recent disease exacerbation despite regular therapy with a beta blocker, angiotensin‑converting enzyme inhibitor or angiotensin receptor-neprilysin inhibitor, and mineralocorticoid receptor antagonist.

Results of the clinical trial VICTORIA proved that vericiguat contributes to the reduced cardiovascular death risk in patients recently hospitalized as a consequence of heart failure exacerbation or those who required intravenous diuretic treatment in an outpatient clinic.

A full potential of the molecule is still to be elucidated taking into account the results of present and future clinical trials. Data from the VICTORIA trial give hope for the future development of heart failure pharmacotherapy.

The utilization of the oral soluble stimulator of guanylate cyclase restores the efficient functionality of the NO-sGC-cGMP signal pathway. This fact together with neurohormonal blockade and afterload reduction achieves the goal of superior heart failure survival closer.

Drugs that induce neurohormonal blockade are very effective in slowing the progression of the disease in stable patients whereas vericiguat may be the drug of choice in high‑risk patients with a history of recent or recurrent hospitalization despite guideline‑directed therapy.

Keywords: heart failure, vericiguat, stimulator of soluble guanylate cyclase, nitric oxide-soluble guanylate cyclase-cyclic guanosine monophosphate pathway.

© Farm Pol, 2021, 77 (10): 615–621