ArticleJACC. Advances2026
Short-Term Effects of Pecavaptan on Weight and Congestion in Acute Heart Failure: The AVANTI Post-Hoc Analysis.
Article in JACC. Advances, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03901729 (A Multicenter, Randomized, Parallel Group, Double Blind, Active and Placebo Controlled Study of BAY1753011, a Dual V1a/V2 Vasopressin Receptor Antagonist, in Patients With Congestive Heart Failure), which is not on this map. Not yet cited in PubMed.
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A Multicenter, Randomized, Parallel Group, Double Blind, Active and Placebo Controlled Study of BAY1753011, a Dual V1a/V2 Vasopressin Receptor Antagonist, in Patients With Congestive Heart Failure: AVANTI Study
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Abstract
backgroundPecavaptan, a dual vasopressin V1a/V2-receptor antagonist, did not enhance weight loss by day 30 in hospitalized heart failure (HF) patients. However, its short-term effects remain unclear.
objectivesThe objective of the study was to evaluate pecavaptan's effect on weight loss and congestion after 7 days.
methodsAVANTI was a double-blind, randomized, placebo-controlled trial in patients hospitalized with HF and incomplete decongestion (n = 482). In part A, patients received pecavaptan (30 mg) (n = 242) or placebo (n = 240) as adjunctive therapy for 30 days. In this post hoc analysis, baseline-adjusted differences in weight change and a composite congestion score (CCS) at day 7 were calculated using analysis of covariance. Individual CCS component effects were assessed using baseline-adjusted ordinal regression at day 7.
resultsPatients had a median age of 70 years (IQR: 62.0-78.0) and 24% (118/482) were women. Pecavaptan resulted in greater weight loss vs placebo by day 7 (-1.43 kg vs -0.95 kg; difference -0.47 kg; 95% CI: -0.94 to -0.01; P = 0.044). Although the CCS was not significantly modified by pecavaptan at day 7 (P = 0.171), we observed a better resolution of pedal edema (adjusted OR: 0.63; 95% CI: 0.42-0.95; nominal P = 0.026) and reduced thoracic fluid content (difference: -1.43%; 95% CI: -2.57 to -0.28; nominal P = 0.015) at day 7. These effects were limited and no longer significant by day 30. An increase in plasma osmolality and serum sodium concentration by pecavaptan was observed at day 7 and day 30 (both P < 0.01).
conclusionsIn patients hospitalized for acute HF with residual congestion, pecavaptan showed modest signals of early decongestion, without durable benefit at 30 days. These post hoc findings require prospective confirmation. (A Trial to Study BAY1753011 in Patients With Congestive Heart Failure [AVANTI]; NCT03901729).
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