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Review
. 2016 Jan 6;6(1):e008545.
doi: 10.1136/bmjopen-2015-008545.

Efficacy and safety of nesiritide in patients with decompensated heart failure: a meta-analysis of randomised trials

Bojun Gong  1 , Zhineng Wu  2 , Zicheng Li  1
Affiliations
Review

Efficacy and safety of nesiritide in patients with decompensated heart failure: a meta-analysis of randomised trials

Bojun Gong et al. BMJ Open. .

Abstract

Objectives: Current evidence suggests that nesiritide may have effects on renal function and decrease the incidence of mortality. However, a clear superiority using nesiritide in terms of renal toxicity and mortality in patients with heart failure was not consistently proven by previous studies. We performed a meta-analysis of all randomised trials to obtain the best estimates of efficacy and safety of nesiritide for the initial treatment of decompensated heart failure.

Method: We performed a meta-analysis of randomised trials of nesiritide in patients with decompensated heart failure (n=38,064 patients, in 22 trials). Two reviewers independently extracted data. Data on efficacy and safety outcomes were collected. We calculated pooled relatives risk (RRs), weighted mean difference and associated 95% CIs.

Results: Compared with placebo, dobutamine and nitroglycerin, nesiritide indicated no increasing risk of total mortality. Compared with the combined control therapy, nesiritide was associated with non-significant differences in short-term mortality (RR 1.24; 95% CI 0.85 to 1.80; p=0.27), mid-term mortality (RR 0.86; 95% CI 0.60 to 1.24; p=0.42) and long-term mortality (RR 0.94; 95% CI 0.75 to 1.18; p=0.61). Nesiritide therapy increased the risk of hypotension (p<0.00 001) and bradycardia (p=0.02) when compared with control therapy. Compared with dobutamine or placebo therapy, no differences in serum creatinine, blood urea nitrogen and creatinine clearance, and no risk of the need for dialysis was observed in nesiritide therapy.

Conclusions: Our findings indicated that, in patients with heart failure, nesiritide was not associated with the risk of mortality. However, it increased the risk of cardiovascular adverse events. The change of serum creatinine and creatinine clearance had no significant difference, and no risk of the need for dialysis was observed after low-dose nesiritide treatment.

Keywords: meta-analysis; mortality; nesiritide.

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Figures

Figure 1
Figure 1
PRISMA flow diagram.
Figure 2
Figure 2
Methodological quality of included studies according to the Cochrane Collaboration’s tool for assessing risk of bias.
Figure 3
Figure 3
Meta-analysis for the comparison of total mortality in nesiritide versus placebo group (RR, risk ratio).
Figure 4
Figure 4
Meta-analysis for the comparison of total mortality in nesiritide versus dobutamine group (RR, risk ratio).
Figure 5
Figure 5
Meta-analysis for the comparison of total mortality in nesiritide versus nitroglycerin group. (RR, risk ratio).
Figure 6
Figure 6
Funnel plots of studies assessing the comparison of short-term mortality in nesiritide therapy versus control therapy (RR, risk ratio).
Figure 7
Figure 7
Funnel plots of studies assessing the comparison of mid-term mortality in nesiritide therapy versus control therapy (RR, risk ratio).
Figure 8
Figure 8
Funnel plots of studies assessing the comparison of long-term mortality in nesiritide therapy versus control therapy (RR, risk ratio).
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References

    1. Sharpe N, Doughty R. Epidemiology of heart failure and ventricular dysfunction. Lancet 1998;352:S13–17. 10.1016/S0140-6736(98)90012-5 - DOI - PubMed
    1. Roger VL, Go AS, Lloyd-Jones DM et al. . Heart disease and stroke statistics—2012 update: a report from the American Heart Association. Circulation 2012;125:e2–220. 10.1161/CIR.0b013e31823ac046 - DOI - PMC - PubMed
    1. Kubo SH, Rector TS, Bank AJ et al. . Endothelium-dependent vasodilation is attenuated in patients with heart failure. Circulation 1991;84:1589–96. 10.1161/01.CIR.84.4.1589 - DOI - PubMed
    1. Varin R, Mulder P, Tamion F et al. . Improvement of endothelial function by chronic angiotensin-converting enzyme inhibition in heart failure: role of nitric oxide, prostanoids, oxidant stress, and bradykinin. Circulation 2000;102:351–6. 10.1161/01.CIR.102.3.351 - DOI - PubMed
    1. Keith M, Geranmayegan A, Sole MJ et al. . Increased oxidative stress in patients with congestive heart failure. J Am Coll Cardiol 1998;31:1352–6. 10.1016/S0735-1097(98)00101-6 - DOI - PubMed

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