VICTORIA Trial of Vericiguat in Heart Failure with Reduced Ejection Fraction

VICTORIA trial was a global study of vericiguat in subjects with heart failure with reduced ejection fraction. Vericiguat increases soluble guanylate cyclase activity and may help to improve myocardial and vascular function by stimulating production of cyclic guanosine monophosphate. VICTORIA was a phase 3, double-blind trial with over 5000 patients with chronic heart failure in NYHA classes II to IV and left ventricular ejection fraction of less than 45%, randomized to receive either vericiguat or placebo. Primary outcome evaluated was a composite of death from cardiovascular causes or first hospitalization for heart failure. Study showed that among patients with high-risk heart failure, the incidence of death from cardiovascular causes or hospitalization for heart failure was lower among those who received vericiguat than among those who received placebo [1]. There was no apparent reduction in all-cause mortality with vericiguat.

9.1% in the vericiguat group had symptomatic hypotension while 7.9% in the placebo group had it (P = 0.12). Syncope occurred in 4% of the study group and 3.5% of the control group (P = 0.30). Data on recurrent hospitalization from the VICTORIA trial has been published in January 2024 [2]. There was no significant difference in treatment effect between patients who had heart failure hospitalization compared to those who did not. Mortality was high after heart failure hospitalization, as expected.

References

1. Armstrong PW, Pieske B, Anstrom KJ, Ezekowitz J, Hernandez AF, Butler J, Lam CSP, Ponikowski P, Voors AA, Jia G, McNulty SE, Patel MJ, Roessig L, Koglin J, O’Connor CM; VICTORIA Study Group. Vericiguat in Patients with Heart Failure and Reduced Ejection Fraction. N Engl J Med. 2020 May 14;382(20):1883-1893. doi: 10.1056/NEJMoa1915928. Epub 2020 Mar 28. PMID: 32222134.
2. Mentz RJ, Stebbins A, Butler J, Chiang CE, Ezekowitz JA, Hernandez AF, Hilkert R, Lam CSP, McDonald K, O’Connor CM, Pieske B, Ponikowski P, Roessig L, Sweitzer NK, Voors AA, Anstrom KJ, Armstrong PW; VICTORIA Study Group. Recurrent Hospitalizations and Response to Vericiguat in Heart Failure and Reduced Ejection Fraction. JACC Heart Fail. 2024 Jan 22:S2213-1779(23)00840-5. doi: 10.1016/j.jchf.2023.12.005. Epub ahead of print. PMID: 38363272.