The TRUE-AHF study was designed to evaluate the efficacy and safety of ularitide, an intravenous synthetic form of the renal vasodilatory natriuretic peptide urodilatin, administered in patients presenting to hospital with acute decompensated heart failure.
The authors of a related editorial note that there is no robust justification for the use of this particular medication – it has only been evaluated in two previous trials, and studies of nesiritide (a related natriuretic peptide) have failed to demonstrate a survival benefit, despite favourable short-term effects on haemodynamics and dyspnoea relief. They go on to discuss various limitations of the study, including exclusion of patients with systolic blood pressure below 116 mmHg (the most compromised cohort of patients) due to concerns of hypotension, and whether the hierarchical clinical composite outcome is a sensitive measure of response to therapy.
The authors of the editorial note that there were some positive effects noted, but conclude that “ularitide, like its predecessor nesiritide, has limited short-term effects that wane after the discontinuation of treatment, which lessens the likelihood that there is a constructive avenue for further development of natriuretic peptides.”