Riociguat significantly improves haemodynamics in patients with pulmonary hypertension with HFpEF: DYNAMIC Trial

"The DYNAMIC trial is the first to evaluate the clinical and hemodynamic consequences of long-term administration of the oral sGC stimulator riociguat in PH-HFpEF patients who had not previously received vasoactive therapy," the authors said.

Key conclusive points:

• In the riociguat group, CO surged by 0.37–1.263 L/min after 26 weeks, while it reduced by 0.11–0.921 L/min in the placebo group (least-squares mean difference: 0.54 L/min, 95% confidence interval: 0.112–0.971; P = 0.0142).
• Riociguat-related side effects led to the withdrawal of five patients, however no deaths or major side effects from the medication were reported.
• Heart rate (HR) remained constant, with mean changes from baseline in the riociguat group being +1.9 ±  20.8 bpm and -0.9 ±  20.0 bpm in the placebo group.
• With a mean difference between treatments of 0.50 L/min (95% CI: 0.058, 0.937; P = 0.0271), analysis using PPS revealed a comparable result for CO change.
• No appreciable improvements in NT-proBNP serum levels, WHO-FC, exercise capacity, or quality of life were seen in conjunction with the indicated hemodynamic alterations.

The researchers concluded that riociguat was safe in the majority of patients with PH-HFpEF, improved CO, PVR, and further pulmonary haemodynamics, but also caused more dropouts and did not alter clinical symptoms during the study period.

"It is important to do more research in appropriately planned trials to determine whether the use of riociguat may affect clinically significant endpoints of morbidity and death," they added.

REFERENCE

Theresa Marie Dachs, Franz Duca, René Rettl, Christina Binder-Rodriguez, Daniel Dalos, Luciana Camuz Ligios, Andreas Kammerlander, Ekkehard Grünig, Ingrid Pretsch, Regina Steringer-Mascherbauer, Klemens Ablasser, Manfred Wargenau, Julia Mascherbauer, Irene M Lang, Christian Hengstenberg, Roza Badr-Eslam, Johannes Kastner, Diana Bonderman, Riociguat in pulmonary hypertension and heart failure with preserved ejection fraction: the haemoDYNAMIC trial, European Heart Journal, Volume 43, Issue 36, 21 September 2022, Pages 3402–3413, https://doi.org/10.1093/eurheartj/ehac389