Serelaxin – neuer medikamentöser Ansatz bei akuter Herzinsuffizienz

Abstract

With approximately 400 000 patients per year acute heart failure is among the most frequent reasons for hospitalization in Germany. In-hospital mortality reaches up to 10 % and up to 30 % over the first six months after discharge. According to the current (update 2012) guidelines of the European Society of Cardiology (ESC) two major forms of acute heart failure can be differentiated, namely (I) with pulmonary congestion/oedema without shock, and (II) with hypotension, hypoperfusion and shock, which require a specific therapeutic regimen (diuretics and vasodilators vs. inotropes). Innovative approaches to treat acute heart failure with the adenosine antagonist rolofylline, the B-type natriuretic peptide nesiritide, the endothelin antagonist tezosentan, and the vasopressin antagonist tolvaptan did not meet the expectations. In contrast, in patients with pulmonary congestion and a systolic blood pressure > 125 mmHg a 48-hr infusion of serelaxin was shown to improve dyspnea (visual analogue scale, but not Likert scale), to shorten length of hospitalization, and to reduce 6-month mortality in the RELAX-AHF study. However, rehospitalization for heart failure or renal failure over the first 60 days was not reduced by serelaxin. Serelaxin is a vasodilator, that has antiinflammatory and antifibrotic properties, improves renal function, and stimulates angiogenesis. Thus, serelaxin has several properties which may explain the persistent effect after a 48-hr infusion. However, a large scale trial is required to prove that the prognostic effect of serelaxin is reproducable and that serelaxin is superior to the currently used therapeutic regimen with high doses of vasodilators (nitrate or nitroprusside). Provided that a clear superiority of serelaxin will be shown in such a trial, this new therapeutic approach should not be witheld to those patients, who fulfill the clinical requirements.