Zusammenfassung
In großen klinischen Studien wurden kürzlich drei innovative pharmakologische Therapieansätze untersucht, die für die Kardiologie in Zukunft vermutlich eine große Rolle spielen werden. Serelaxin ist ein vasoaktives Peptidhormon, das während der Schwangerschaft gebildet wird und dabei den Gefäßwiderstand senkt, das Herzzeitvolumen steigert und die Nierenfunktion verbessert. Kürzlich konnte gezeigt werden, dass die Gabe von Serelaxin bei Patienten mit akuter Herzinsuffizienz die klinische Stauungssymptomatik verbessert. Als sekundärer Endpunkt war sogar die 180-Tage-Mortalität reduziert. Mit Serelaxin könnte somit eine neue Therapie mit prognostischer Bedeutung für die akute Herzinsuffizienz zur Verfügung stehen. Edoxaban ist ein selektiver Faktor-Xa-Inhibitor, der die Thrombinproduktion und Thrombusbildung hemmt. Zwei kürzlich publizierte Studien fanden, dass Edoxaban in der Prävention und Behandlung venöser Thromboembolien sowie in der Vorbeugung von Schlaganfällen und systemischen Embolien bei Vorhofflimmern mindestens genauso effektiv wie der Vitamin-K-Antagonist Warfarin ist. Im Vergleich zu Warfarin reduziert Edoxaban signifikant schwere Blutungskomplikationen. Mit Edoxaban wird vermutlich zeitnah das vierte vielversprechende neue orale Antikoagulans Marktreife erreichen. Die Serinprotease „proprotein convertase subtilisin/kexin 9“ (PCSK9) reduziert die Fähigkeit der Leber, Low-density-lipoprotein-Cholesterin (LDL-C) zu binden und so aus dem Blut zu entfernen. Kürzlich wurde ein monoklonaler Antikörper für PCSK9 entwickelt, der in klinischen Studien eine bis zu 73 %ige LDL-C-Senkung bewirkte sowie die Lipoprotein(a)- und Apolipoprotein-B-Werte reduzierte. Mit den PCSK9-Inhibitoren ist wahrscheinlich bald eine aussichtsreiche Medikation mit einem neuartigen Wirkmechanismus zur LDL-C-Reduktion verfügbar.
Abstract
Three innovative pharmaceuticals which might play an important role in the field of cardiology in the near future were recently tested in large clinical studies. Serelaxin, a vasoactive hormone peptide that is produced during pregnancy, reduces vessel resistance, increases cardiac output, and improves renal function. Lately, it was demonstrated that serelaxin significantly reduces congestion symptoms in patients with acute heart failure. As a secondary endpoint the mortality at day 180 was reduced. Therefore, serelaxin seems to be a promising new drug for the treatment of acute heart failure which might have a prognostic impact. Edoxaban is a selective factor Xa inhibitor, which inhibits thrombin production and thrombus formation. Two recently published studies reported that edoxaban is at least as effective as the vitamin K antagonist warfarin in prevention and treatment of venous thromboembolism and in the prevention of stroke and systemic embolism due to nonvalvular atrial fibrillation. Compared to warfarin, edoxaban significantly exhibited less frequent severe bleeding complications. Edoxaban will probably soon be the fourth new oral anticoagulant available for patients. The serine protease proprotein convertase subtilisin/kexin 9 (PCSK9) reduces the ability of the liver to bind low-density lipoprotein cholesterol (LDL-C) and to remove it from the circulation. Recently, a monoclonal antibody for PCSK9 was developed which induces a LDL-C plasma level reduction up to 73 % and also decreases lipoprotein(a) and apolipoprotein B. PCSK9 inhibition is a promising new mechanism for LDL-C reduction and the corresponding drug will be presumably approved soon by the regulatory authorities.
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Einhaltung ethischer Richtlinien
Interessenkonflikt. F.S. Czepluch gibt an, dass kein Interessenkonflikt besteht. G. Hasenfuß hat Vortrags- und/oder Beraterhonorare der Firmen Novartis, Servier, Impulse Dynamics, CircuLite, AstraZeneca, Bayer und DC Devices erhalten. C. Jacobshagen hat Vortrags- und/oder Beraterhonorare der Firmen Novartis, Daichii Sankyo, Pfizer, Bristol-Myers Squibb, Boehringer Ingelheim, AstraZeneca, Berlin-Chemie und Servier erhalten. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.
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Czepluch, F., Hasenfuß, G. & Jacobshagen, C. Neue Medikamente in der Kardiologie. Internist 55, 382–389 (2014). https://doi.org/10.1007/s00108-013-3418-1
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DOI: https://doi.org/10.1007/s00108-013-3418-1