From the Guidelines
Vericiguat is indicated for the treatment of symptomatic chronic heart failure with reduced ejection fraction (HFrEF) in adult patients who are stabilized after a recent heart failure decompensation event requiring intravenous therapy, to reduce the risk of cardiovascular death and heart failure hospitalization, as evidenced by the VICTORIA trial 1. The patient population that benefits from vericiguat includes those with an ejection fraction less than 45%, New York Heart Association (NYHA) class II to IV, who are on guideline-directed medical therapy (GDMT), with elevated natriuretic peptides, and recent heart failure worsening, as defined by hospitalization within 6 months or recently received intravenous diuretic therapy without hospitalization 1. Key considerations for the use of vericiguat include:
- Starting dose of 2.5 mg once daily, with titration at 2-week intervals to 5 mg once daily, then to the target maintenance dose of 10 mg once daily as tolerated
- Mechanism of action as a soluble guanylate cyclase (sGC) stimulator, enhancing the body's nitric oxide-sGC-cyclic guanosine monophosphate (cGMP) pathway to improve myocardial and vascular function
- Monitoring for hypotension, with blood pressure assessment before and during treatment
- Contraindications and precautions, including use in pregnancy, with specific phosphodiesterase-5 inhibitors like sildenafil, and caution in severe renal impairment, as noted in the 2022 AHA/ACC/HFSA guideline for the management of heart failure 1. The VICTORIA trial demonstrated a reduction in the primary outcome of cardiovascular death or heart failure hospitalization with vericiguat compared to placebo, with a hazard ratio of 0.90 (P=0.019) 1. However, it is essential to consider the potential for symptomatic hypotension and syncope, which were numerically higher in the vericiguat group versus placebo, although not statistically significant 1. Overall, vericiguat offers a novel therapeutic approach for patients with HFrEF, particularly those with recent worsening of heart failure, by targeting the sGC-cGMP pathway to improve outcomes.
From the FDA Drug Label
VERQUVO® is indicated to reduce the risk of cardiovascular death and heart failure (HF) hospitalization following a hospitalization for heart failure or need for outpatient IV diuretics, in adults with symptomatic chronic HF and ejection fraction less than 45% [see Clinical Studies (14)].
The indication for Vericiguat (Verquvo) is to reduce the risk of cardiovascular death and heart failure hospitalization in adults with:
- Symptomatic chronic heart failure
- Ejection fraction less than 45%
- Following a hospitalization for heart failure or need for outpatient IV diuretics 2.
From the Research
Indication for Vericiguat (Verquvo)
- Vericiguat is indicated for the treatment of adults with symptomatic, chronic heart failure with reduced ejection fraction (HFrEF) who have experienced a recent worsening event 3, 4, 5.
- The treatment is aimed at reducing the risk of cardiovascular death and heart failure hospitalization in patients with symptomatic congestive heart failure with ejection fraction less than 45% 4.
- Vericiguat is approved for use in patients who are stabilized after a recent decompensation event, such as those who have been hospitalized for heart failure or require outpatient intravenous diuretics 6, 7, 4.
Patient Population
- Vericiguat is intended for adult patients with symptomatic chronic heart failure and reduced ejection fraction (less than 45%) 3, 4, 5.
- Patients should have experienced a recent worsening event, such as hospitalization for heart failure or need for outpatient intravenous diuretics 4.