Patiromer Facilitates Angiotensin Inhibitor and Mineralocorticoid Antagonist Therapies in Patients With Heart Failure and Hyperkalemia

Bertram Pitt; Stefan D. Anker; Lars H. Lund; Andrew J.S. Coats; Gerasimos Filippatos; Patrick Rossignol; Matthew R. Weir; Tim Friede; Mikhail N. Kosiborod; Marco Metra; Michael Böhm; Justin A. Ezekowitz; Antoni Bayes-Genis; Robert J. Mentz; Piotr Ponikowski; Michele Senni; Ileana L. Piña; Fausto J. Pinto; Peter van der Meer; Cecilia Bahit; Jan Belohlavek; Jasper J. Brugts; Amandine Perrin; Sandra Waechter; Jeffrey Budden; Javed Butler

doi:10.1016/j.jacc.2024.05.079

Patiromer Facilitates Angiotensin Inhibitor and Mineralocorticoid Antagonist Therapies in Patients With Heart Failure and Hyperkalemia

Bertram Pitt^*, Stefan D. Anker, Lars H. Lund, Andrew J.S. Coats, Gerasimos Filippatos, Patrick Rossignol, Matthew R. Weir, Tim Friede, Mikhail N. Kosiborod, Marco Metra, Michael Böhm, Justin A. Ezekowitz, Antoni Bayes-Genis, Robert J. Mentz, Piotr Ponikowski, Michele Senni, Ileana L. Piña, Fausto J. Pinto, Peter van der Meer, Cecilia BahitJan Belohlavek, Jasper J. Brugts, Amandine Perrin, Sandra Waechter, Jeffrey Budden, Javed Butler

^*Corresponding author for this work

Cardiology

Research output: Contribution to journal › Article › Academic › peer-review

1 Citation (Scopus)

Abstract

Background:

Hyperkalemia (HK) is associated with suboptimal renin–angiotensin system (RAS) inhibitor and mineralocorticoid receptor antagonist (MRA) use in heart failure with reduced ejection fraction (HFrEF).

Objectives:

This study sought to assess characteristics and RAS inhibitor/MRA use in patients receiving patiromer during the DIAMOND (Patiromer for the Management of Hyperkalemia in Subjects Receiving RAASi Medications for the Treatment of Heart Failure) run-in phase.

Methods:

Patients with HFrEF and HK or past HK entered a run-in phase of ≤12 weeks with patiromer-facilitated RAS inhibitor/MRA optimization to achieve ≥50% recommended RAS inhibitor dose, 50 mg/d MRA, and normokalemia. Patients achieving these criteria (randomized group) were compared with the run-in failure group (patients not meeting the randomization criteria).

Results:

Of 1,038 patients completing the run-in, 878 (84.6%) were randomized and 160 (15.4%) were run-in failures. Overall, 422 (40.7%) had HK entering run-in with a similar frequency in the randomized and run-in failure groups (40.3% vs 42.5%; P = 0.605). From start to the end of run-in, in the randomized group, an increase was observed in target RAS inhibitor and MRA use in patients with HK (RAS inhibitor: 76.8% to 98.6%; MRA: 35.9% to 98.6%) and past HK (RAS inhibitor: 60.5% to 98.1%; MRA: 15.6% to 98.7%). Despite not meeting the randomization criteria, an increase after run-in was observed in the run-in failure group in target RAS inhibitor (52.5% to 70.6%) and MRA use (15.0% to 48.1%). This increase was observed in patients with HK (RAS inhibitor: 51.5% to 64.7%; MRA: 19.1% to 39.7%) and past HK (RAS inhibitor: 53.3% to 75.0%; MRA: 12.0% to 54.3%).

Conclusions:

In patients with HFrEF and HK or past HK receiving suboptimal RAS inhibitor/MRA therapy, RAS inhibitor/MRA optimization increased during patiromer-facilitated run-in.

Original language	English
Pages (from-to)	1295-1308
Number of pages	14
Journal	Journal of the American College of Cardiology
Volume	84
Issue number	14
DOIs	https://doi.org/10.1016/j.jacc.2024.05.079
Publication status	Published - 1 Oct 2024

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© 2024 The Authors

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Pitt, B., Anker, S. D., Lund, L. H., Coats, A. J. S., Filippatos, G., Rossignol, P., Weir, M. R., Friede, T., Kosiborod, M. N., Metra, M., Böhm, M., Ezekowitz, J. A., Bayes-Genis, A., Mentz, R. J., Ponikowski, P., Senni, M., Piña, I. L., Pinto, F. J., van der Meer, P., ... Butler, J. (2024). Patiromer Facilitates Angiotensin Inhibitor and Mineralocorticoid Antagonist Therapies in Patients With Heart Failure and Hyperkalemia. Journal of the American College of Cardiology, 84(14), 1295-1308. https://doi.org/10.1016/j.jacc.2024.05.079

@article{caf1ab9e8f8b48879383d06d96ed6242,

title = "Patiromer Facilitates Angiotensin Inhibitor and Mineralocorticoid Antagonist Therapies in Patients With Heart Failure and Hyperkalemia",

abstract = "Background: Hyperkalemia (HK) is associated with suboptimal renin–angiotensin system (RAS) inhibitor and mineralocorticoid receptor antagonist (MRA) use in heart failure with reduced ejection fraction (HFrEF). Objectives: This study sought to assess characteristics and RAS inhibitor/MRA use in patients receiving patiromer during the DIAMOND (Patiromer for the Management of Hyperkalemia in Subjects Receiving RAASi Medications for the Treatment of Heart Failure) run-in phase. Methods: Patients with HFrEF and HK or past HK entered a run-in phase of ≤12 weeks with patiromer-facilitated RAS inhibitor/MRA optimization to achieve ≥50% recommended RAS inhibitor dose, 50 mg/d MRA, and normokalemia. Patients achieving these criteria (randomized group) were compared with the run-in failure group (patients not meeting the randomization criteria). Results: Of 1,038 patients completing the run-in, 878 (84.6%) were randomized and 160 (15.4%) were run-in failures. Overall, 422 (40.7%) had HK entering run-in with a similar frequency in the randomized and run-in failure groups (40.3% vs 42.5%; P = 0.605). From start to the end of run-in, in the randomized group, an increase was observed in target RAS inhibitor and MRA use in patients with HK (RAS inhibitor: 76.8% to 98.6%; MRA: 35.9% to 98.6%) and past HK (RAS inhibitor: 60.5% to 98.1%; MRA: 15.6% to 98.7%). Despite not meeting the randomization criteria, an increase after run-in was observed in the run-in failure group in target RAS inhibitor (52.5% to 70.6%) and MRA use (15.0% to 48.1%). This increase was observed in patients with HK (RAS inhibitor: 51.5% to 64.7%; MRA: 19.1% to 39.7%) and past HK (RAS inhibitor: 53.3% to 75.0%; MRA: 12.0% to 54.3%). Conclusions: In patients with HFrEF and HK or past HK receiving suboptimal RAS inhibitor/MRA therapy, RAS inhibitor/MRA optimization increased during patiromer-facilitated run-in.",

author = "Bertram Pitt and Anker, {Stefan D.} and Lund, {Lars H.} and Coats, {Andrew J.S.} and Gerasimos Filippatos and Patrick Rossignol and Weir, {Matthew R.} and Tim Friede and Kosiborod, {Mikhail N.} and Marco Metra and Michael B{\"o}hm and Ezekowitz, {Justin A.} and Antoni Bayes-Genis and Mentz, {Robert J.} and Piotr Ponikowski and Michele Senni and Pi{\~n}a, {Ileana L.} and Pinto, {Fausto J.} and {van der Meer}, Peter and Cecilia Bahit and Jan Belohlavek and Brugts, {Jasper J.} and Amandine Perrin and Sandra Waechter and Jeffrey Budden and Javed Butler",

note = "Publisher Copyright: {\textcopyright} 2024 The Authors",

year = "2024",

month = oct,

day = "1",

doi = "10.1016/j.jacc.2024.05.079",

language = "English",

volume = "84",

pages = "1295--1308",

journal = "Journal of the American College of Cardiology",

issn = "0735-1097",

publisher = "Elsevier Inc.",

number = "14",

}

Pitt, B, Anker, SD, Lund, LH, Coats, AJS, Filippatos, G, Rossignol, P, Weir, MR, Friede, T, Kosiborod, MN, Metra, M, Böhm, M, Ezekowitz, JA, Bayes-Genis, A, Mentz, RJ, Ponikowski, P, Senni, M, Piña, IL, Pinto, FJ, van der Meer, P, Bahit, C, Belohlavek, J, Brugts, JJ, Perrin, A, Waechter, S, Budden, J & Butler, J 2024, 'Patiromer Facilitates Angiotensin Inhibitor and Mineralocorticoid Antagonist Therapies in Patients With Heart Failure and Hyperkalemia', Journal of the American College of Cardiology, vol. 84, no. 14, pp. 1295-1308. https://doi.org/10.1016/j.jacc.2024.05.079

TY - JOUR

T1 - Patiromer Facilitates Angiotensin Inhibitor and Mineralocorticoid Antagonist Therapies in Patients With Heart Failure and Hyperkalemia

AU - Pitt, Bertram

AU - Anker, Stefan D.

AU - Lund, Lars H.

AU - Coats, Andrew J.S.

AU - Filippatos, Gerasimos

AU - Rossignol, Patrick

AU - Weir, Matthew R.

AU - Friede, Tim

AU - Kosiborod, Mikhail N.

AU - Metra, Marco

AU - Böhm, Michael

AU - Ezekowitz, Justin A.

AU - Bayes-Genis, Antoni

AU - Mentz, Robert J.

AU - Ponikowski, Piotr

AU - Senni, Michele

AU - Piña, Ileana L.

AU - Pinto, Fausto J.

AU - van der Meer, Peter

AU - Bahit, Cecilia

AU - Belohlavek, Jan

AU - Brugts, Jasper J.

AU - Perrin, Amandine

AU - Waechter, Sandra

AU - Budden, Jeffrey

AU - Butler, Javed

PY - 2024/10/1

Y1 - 2024/10/1

N2 - Background: Hyperkalemia (HK) is associated with suboptimal renin–angiotensin system (RAS) inhibitor and mineralocorticoid receptor antagonist (MRA) use in heart failure with reduced ejection fraction (HFrEF). Objectives: This study sought to assess characteristics and RAS inhibitor/MRA use in patients receiving patiromer during the DIAMOND (Patiromer for the Management of Hyperkalemia in Subjects Receiving RAASi Medications for the Treatment of Heart Failure) run-in phase. Methods: Patients with HFrEF and HK or past HK entered a run-in phase of ≤12 weeks with patiromer-facilitated RAS inhibitor/MRA optimization to achieve ≥50% recommended RAS inhibitor dose, 50 mg/d MRA, and normokalemia. Patients achieving these criteria (randomized group) were compared with the run-in failure group (patients not meeting the randomization criteria). Results: Of 1,038 patients completing the run-in, 878 (84.6%) were randomized and 160 (15.4%) were run-in failures. Overall, 422 (40.7%) had HK entering run-in with a similar frequency in the randomized and run-in failure groups (40.3% vs 42.5%; P = 0.605). From start to the end of run-in, in the randomized group, an increase was observed in target RAS inhibitor and MRA use in patients with HK (RAS inhibitor: 76.8% to 98.6%; MRA: 35.9% to 98.6%) and past HK (RAS inhibitor: 60.5% to 98.1%; MRA: 15.6% to 98.7%). Despite not meeting the randomization criteria, an increase after run-in was observed in the run-in failure group in target RAS inhibitor (52.5% to 70.6%) and MRA use (15.0% to 48.1%). This increase was observed in patients with HK (RAS inhibitor: 51.5% to 64.7%; MRA: 19.1% to 39.7%) and past HK (RAS inhibitor: 53.3% to 75.0%; MRA: 12.0% to 54.3%). Conclusions: In patients with HFrEF and HK or past HK receiving suboptimal RAS inhibitor/MRA therapy, RAS inhibitor/MRA optimization increased during patiromer-facilitated run-in.

AB - Background: Hyperkalemia (HK) is associated with suboptimal renin–angiotensin system (RAS) inhibitor and mineralocorticoid receptor antagonist (MRA) use in heart failure with reduced ejection fraction (HFrEF). Objectives: This study sought to assess characteristics and RAS inhibitor/MRA use in patients receiving patiromer during the DIAMOND (Patiromer for the Management of Hyperkalemia in Subjects Receiving RAASi Medications for the Treatment of Heart Failure) run-in phase. Methods: Patients with HFrEF and HK or past HK entered a run-in phase of ≤12 weeks with patiromer-facilitated RAS inhibitor/MRA optimization to achieve ≥50% recommended RAS inhibitor dose, 50 mg/d MRA, and normokalemia. Patients achieving these criteria (randomized group) were compared with the run-in failure group (patients not meeting the randomization criteria). Results: Of 1,038 patients completing the run-in, 878 (84.6%) were randomized and 160 (15.4%) were run-in failures. Overall, 422 (40.7%) had HK entering run-in with a similar frequency in the randomized and run-in failure groups (40.3% vs 42.5%; P = 0.605). From start to the end of run-in, in the randomized group, an increase was observed in target RAS inhibitor and MRA use in patients with HK (RAS inhibitor: 76.8% to 98.6%; MRA: 35.9% to 98.6%) and past HK (RAS inhibitor: 60.5% to 98.1%; MRA: 15.6% to 98.7%). Despite not meeting the randomization criteria, an increase after run-in was observed in the run-in failure group in target RAS inhibitor (52.5% to 70.6%) and MRA use (15.0% to 48.1%). This increase was observed in patients with HK (RAS inhibitor: 51.5% to 64.7%; MRA: 19.1% to 39.7%) and past HK (RAS inhibitor: 53.3% to 75.0%; MRA: 12.0% to 54.3%). Conclusions: In patients with HFrEF and HK or past HK receiving suboptimal RAS inhibitor/MRA therapy, RAS inhibitor/MRA optimization increased during patiromer-facilitated run-in.

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U2 - 10.1016/j.jacc.2024.05.079

DO - 10.1016/j.jacc.2024.05.079

M3 - Article

C2 - 39322323

AN - SCOPUS:85203997562

SN - 0735-1097

VL - 84

SP - 1295

EP - 1308

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

IS - 14

ER -

Patiromer Facilitates Angiotensin Inhibitor and Mineralocorticoid Antagonist Therapies in Patients With Heart Failure and Hyperkalemia

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