Clinical Trial Details
— Status: Not yet recruiting
Administrative data
NCT number |
NCT05704478 |
Other study ID # |
22-2321 |
Secondary ID |
|
Status |
Not yet recruiting |
Phase |
Phase 4
|
First received |
|
Last updated |
|
Start date |
January 1, 2024 |
Est. completion date |
March 31, 2027 |
Study information
Verified date |
May 2023 |
Source |
University of Colorado, Denver |
Contact |
Kyle Schtul |
Phone |
303.724.2095 |
Email |
kyle.schtul[@]cuanschutz.edu |
Is FDA regulated |
No |
Health authority |
|
Study type |
Interventional
|
Clinical Trial Summary
Vericiguat is a new drug that was recently approved by the Food and Drug Administration for
patients with heart failure. In a large randomized controlled trial, this drug was found to
help patients with heart failure live longer and stay out of the hospital more than normal
treatment for heart failure. However, it is unclear how this drug positively impacts
"hemodynamics", meaning how the heart functions during activity/exercise, and how it may also
help blood pressure and health of the blood vessels and autonomic nervous system. This study,
funded by the drug manufacturer, Merck Corp, will enroll 30 patients with heart failure. The
patients will undergo baseline testing, and then be randomized to either receive vericiguat
or a placebo for about three months, and then come back for follow-up testing to learn more
about how the drug impacts heart function.
Description:
Vericiguat is an oral soluble guanylate cyclase (sGC) stimulator, which enhances sGC
sensitivity to nitric oxide (NO). Patients with heart failure with reduced ejection fraction
(HFrEF) are known to have a reduction in NO bioavailability as a result of endothelial
dysfunction, oxidative stress2 and presence of reactive oxygen species. In turn, there is a
reduction in sGC activity, which is associated with multiple adverse cardiac effects,
including cardiac stiffness and fibrosis, microvascular dysfunction and ultimately,
propagation of HFrEF. In a large, multi-center randomized placebo controlled trial,
vericiguat reduced the incidence of death from cardiovascular causes or hospitalization for
heart failure. The VICTORIA trial demonstrated that on a larger scale (N=5050 patients),
modulation of the NO-sGC pathway led to stabilization and improvement of the heart failure
syndrome, which translated into improvements in hard outcomes.
There are a paucity of data, however, characterizing the direct effects of vericiguat on left
ventricular function among humans suffering from HFrEF. The echocardiographic substudy of
VICTORIA found that left ventricular ejection fraction (LVEF) improved from baseline to 8
months follow-up in both the placebo arm (31.8±8.2% to 34.2±9.2%, P<0.001) and the vericiguat
arm (33.0±9.4% to 36.1±10.1%, P<0.001) and that LV end-systolic volume index (LVESVI) also
declined in both arms. However, non-invasive, echocardiographic-derived metrics of
ventricular function are relatively insensitive when compared to invasive determinants of
overall cardiovascular performance. Thus, longitudinal changes in metrics such as LVEF and
LVESVI, while informative, may not sufficiently characterize the physiologic adaptations that
occur following modulation of the NO-sGC pathway, which in turn, translate into improvements
in hard outcomes, which were observed in the VICTORIA trial.
The primary objective of this proposal is to precisely characterize the impact of NO-sGC
modulation with the novel agent vericiguat on vascular biology, as well as resting and
exertional cardiovascular performance among patients with heart failure with reduced ejection
fraction (HFrEF). Our central hypothesis is that vericiguat improves endothelial function,
which promotes arterial vasodilatation - and consequently, reduces left and right ventricular
afterload. This reduction in afterload improves ventricular contractility, and in turn,
reduces HFrEF severity by improving left and right-sided cardiovascular performance. This
hypothesis will be tested through comprehensive assessment of longitudinal changes in
vascular biology and cardiopulmonary performance among patients with HFrEF prior to, and
following initiation of the novel oral sGC stimulator, vericiguat.