Effects of a Novel Nitroxyl Donor in Acute Heart Failure: The STAND-UP AHF Study

OBJECTIVES The primary objective was to identify well-tolerated doses of cimlanod in patients with acute heart failure (AHF). Secondary objectives were to identify signals of efficacy, including biomarkers, symptoms, and clinical events.BACKGROUND Nitroxyl (HNO) donors have vasodilator, inotropic and lusitropic effects. Bristol-Myers Squibb-986231 (dmlanod) is an HNO donor being developed for acute heart failure (AHF).METHODS This was a phase lib, double-blind, randomized, placebo-controlled trial of 48-h treatment with cimtanod compared with placebo in patients with left ventricular ejection fraction <= 40% hospitalized for AHF. In part I, patients were randomized in a 1:1 ratio to escalating doses of cimtanod or matching placebo. In part H, patients were randomized in a 1:1:1 ratio to either of the 2 highest tolerated doses of cimlanod from part I or placebo. The primary endpoint was the rate of clinically relevant hypotension (systolic blood pressure <90 mm Hg or patients became symptomatic).RESULTS In part I (n = 100), clinically relevant hypotension was more common with cimtanod than placebo (20% vs. 8%; relative risk [RR]: 2.45; 95% confidence interval (C1): 0.83 to 14.53). In part H (n 222), the incidence of clinically relevant hypotension was 18% for placebo, 21% for cimtanod 6 mu g/kg/min (RR: 1.15; 95% CI: 0.58 to 2.43), and 35% for cimlanod 12 mu g/kg/min (RR: 1.9; 95% CI: 1.04 to 3.59). N-terminal pro-B-type natriuretic peptide and bilirubin decreased during infusion of cimtanod treatment compared with placebo, but these differences did not persist after treatment discontinuation.CONCLUSIONS Cimlanod at a dose of 6 mu g/kg/min was reasonably well-tolerated compared with placebo. Cimlanod reduced markers of congestion, but this did not persist beyond the treatment period. (Evaluate the Safety and Efficacy of 48-Hour Infusions of HNO (Nitroxyl) Donor in Hospitalized Patients With Heart Failure [STANDUP AHF]; NCT03016325) (C) 2021 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation.