Emerging treatments

Levosimendan

Levosimendan is an inodilator, meaning it provides inotropy with vasodilation. It has been licensed in Europe since the 2000s for the short-term treatment of acutely decompensated severe chronic heart failure when conventional therapy is not sufficient, and in cases where inotropic support is considered appropriate.[108] It is not approved for use in the US but remains under active clinical investigation.[108] Randomised controlled trials in adults have shown that levosimendan improves clinical outcomes and is generally well tolerated.[109][110] Evidence of levosimendan improving mortality versus other inodilators such as dobutamine remains conflicting.[111][112] Levosimendan has also demonstrated efficacy in the paediatric population with an acceptable safety profile. Results from a single-centre retrospective study suggested that levosimendan may reduce the need for mechanical circulatory support in children undergoing cardiac surgery or with decompensated heart failure.[113] Other studies have shown that levosimendan has similar efficacy to or is superior to milrinone in neonates and children.[114][115] Despite these findings, robust clinical trial evidence for levosimendan in paediatric patients remains lacking.[108] Levosimendan is being investigated for other indications including pulmonary hypertension and septic shock.[116] It failed to demonstrate superiority to placebo in patients with amyotrophic lateral sclerosis.[117]

Use of this content is subject to our disclaimer