Heart failure is the ultimate “Cinderella Syndrome” but just recently Prince Charming (Pharma and Biotechs) maybe offering that glass slipper.
New treatments for heart failure have been scarce to say the least and have remained largely unchanged since the 1970s. Every year some 3.5 million people in America and Europe are admitted to hospital suffering from acute heart failure. Heart Failure equates to 5% of all AE admissions and takes 2% of the total beds in the NHS. Around 30% of patients are likely to die within a year. Drugs are given to alleviate symptoms, like breathlessness, congestion and pain. However in the past two decades only a couple of new drugs and a metamorphosing of new strains of drugs have been approved to help patients. Now a number of treatments for heart failure are in the pipeline which is very good news for those suffering from acute and chronic heart failure. The positive line is that more people are surviving heart attacks (cardiac MI) but then they come out the other side sometimes with heart failure, this is where patients and their families need to manage this long term condition
New development amount to a “seismic shift in the clinical landscape” for acute heart failure, says Martin Cowie, professor of cardiology at the Royal Brompton Hospital in London. The new drugs being developed not only appear to reduce mortality rates, he adds, but also help to avoid long-lasting damaging effects to organs.
Some of the existing drug treatments work by impairing and dampening the body’s own response to cardiac conditions. For example, beta blockers, also given to those who suffer heart attacks, interfere with receptors on cells in the heart muscle to weaken the effect of stress hormones binding with those cells. Some of the new treatments instead exaggerate and increase the natural reactions to heart stress that occur in healthy people.
One such drug is a compound called serelaxin, which has been developed by Novartis, a Swiss. It mimics a human hormone known as relaxin. In pregnancy relaxin levels rise to help boost the blood flow for mother and child. This can also help patients whose hearts are coming under a similar sort of stress. Positive results were reported in a medical trial of serelaxin by the Lancet last year and the drug could be licensed for use next year. Serelaxin also in recent FDA trials reduced the risk of death by 37% for those with acute heart failure in the period of 6 months after diagnosis.
Another drug that mimics a natural process is ularitide. This has been developed by Cardiorentis, also a Swiss company, as a chemically synthesised form of urodilatin—a human peptide which is produced in the kidneys and which helps them excrete waste more efficiently through manipulating hormone levels. This too can improve blood flow and further trials are planned.
Two American biotechnology companies, Amgen and Cytokinetics, reported results from a trial of a drug called omecamtiv mecarbil to a recent congress held in Amsterdam by the European Society of Cardiology. Although more tests are needed, the drug has been shown to stimulate the ability of heart muscles to contract without debilitating side-effects. Previous drugs that made the heart contract more powerfully tended to raise calcium levels, which increases the risk of life-threatening heart-rhythm problems.
In the longer term, techniques are emerging which might help repair the damaged heart itself. Celladon, another American biotechnology company, is funding a clinical trial of a gene therapy in a number of hospitals around the world. The trial, known as CUPID2, involves introducing a gene which can help the heart improve its muscle function. The gene is contained in a genetically engineered virus and inserted directly into heart muscle via a catheter. If the trial is successful, such treatment could be four or five years away from being made generally available.
More work is needed. But after such a long period of little progress acute heart failure might at last start to benefit from the sort of advances that have made heart attacks less deadly.
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