Novel treatment strategies to manage potassium in Heart Failure - PowerPoint PPT Presentation

Potassium binding drugs Novel treatment strategies to manage potassium in Heart Failure Peter van der Meer, MD PhD FESC cardiologist University Medical Center Groningen The Netherlands University Medical Center Groningen

Potassium binding drugs Therapeutic options for Hyperkalemia • Acute therapies: - insulin, beta-adrenergic agonist (nebulized), sodium bicarbonate) - Dialysis (invasive and expensive) Chronic therapies University Medical Center Groningen

Potassium binding drugs University Medical Center Groningen

Potassium binding drugs Given the non-selective binding and side effects, there is a clinical need for hyperkalemia treatment that is effective, safe and well-tolerated 2 novel potassium binders: • Patiromer • ZS-9 University Medical Center Groningen

Potassium binding drugs Patiromer University Medical Center Groningen

Potassium binding drugs • Effect of patiromer on serum potassium - Diabetes (type 2), N=306 - eGFR 15-60 ml/min - RAASi - Potassium > 5 mmol/L • Endpoint: Efficacy: Change in K+ (baseline – week 4) Safety: adverse events during 1 year FU University Medical Center Groningen

Potassium binding drugs NB: no placebo group University Medical Center Groningen

Potassium binding drugs • N=104, chronic HF • History of Hyper K+ • CKD: GFR<60 ml/min/1.73m2 • Patiromer vs Placebo • Efficacy Endpoint: change in potassium • Safety endpoint: AE University Medical Center Groningen

Efficacy Potassium binding drugs University Medical Center Groningen

Potassium binding drugs Safety University Medical Center Groningen

Potassium binding drugs Van der Meer et al. Eur Heart J 2011 University Medical Center Groningen

Potassium binding drugs ZS-9 University Medical Center Groningen

Potassium binding drugs • N=753 • K+ 5.0-6.5 • Endpoint: change K+ University Medical Center Groningen

Potassium binding drugs Effect of ZS-9 in the first 48 hrs University Medical Center Groningen

Potassium binding drugs University Medical Center Groningen

Potassium binding drugs Safety profile University Medical Center Groningen

Potassium binding drugs Subgroup analysis HF patients • N=94 • Reported HF • Effect on Potassium • AE in this subgroup University Medical Center Groningen Eur J Heart Fail 2015

Potassium binding drugs Efficacy Early phase – open label Randomized fase (double-blind-placebo) University Medical Center Groningen

Potassium binding drugs Efficacy of the 4 groups University Medical Center Groningen

Potassium binding drugs Safety profile SA in >1 patient reported University Medical Center Groningen

Potassium binding drugs Conclusions • Older potassium binding agents lead to serious side effects • Novel K-binding drugs have a favorable safety profile • Both drugs are highly effective in lowering potassium • Higher dosages of spironolactone can be achieved • Whether this results in an improved outcome is unclear University Medical Center Groningen