The VICTORIA trial was a randomized controlled trial that tested the use of vericiguat in patients with heart failure with reduced ejection fraction. Vericiguat is an oral soluble guanylate cyclase stimulator with associated vasodilatory effects. It acts by stimulating the production of cyclic guanosine monophosphate cGMP that then help to improve myocardial and vascular function.
In the Vericiguat Global Study in Subjects with Heart Failure with Reduced Ejection Fraction – VICTORIA trial, 5050 patients with chronic HF (New York Heart Association [NYHA] functional class II, III, or IV) with LVEF <45 percent (86 percent with LVEF <40 percent) and recent elevated natriuretic peptide level were randomly assigned to vericiguat (target dose 10 mg once daily) or placebo.
During follow-up, there was a borderline significant reduction in hospitalization for HF with vericiguat compared with placebo (27.4 versus 29.6 percent; HR 0.90, 95% CI 0.81-1.00). Death from cardiovascular causes was not significantly lower with vericiguat (16.4 versus 17.5 percent; HR 0.93, 95% CI 0.81-1.06).
The composite outcome of the first hospitalization for HF or death from cardiovascular causes was lower in the vericiguat group (35.5 versus 38.5 percent; HR 0.90, 95% CI 0.82-0.98). The composite of death from any cause or hospitalization for HF was also reduced with vericiguat (37.9 versus 40.9 percent; HR 0.90, 95% CI 0.83-0.98).
In addition to benefits above, vericiguat was found to be safe for the patients and was not associated with any serious adverse effects. The authors of the VICTORIA trial concluded that among patients with high-risk heart failure, the incidence of death from cardiovascular causes or hospitalization for heart failure was lower among those who received vericiguat than among those who received placebo.
For more on vasodilators in heart failure, check out the RELAX trial that studied the effects of sildanifil in heart failure with reduced ejection fraction.