Rationale and Design of the Double-Blind, Randomized, Placebo-Controlled Multicenter Trial on Efficacy of Early Initiation of Eplerenone Treatment in Patients with Acute Heart Failure (EARLIER)

Masanori Asakura, Haruko Yamamoto, Kuniya Asai, Akihisa Hanatani, Ken ichi Hirata, Atsushi Hirayakma, Kazuo Kimura, Youichi Kobayashi, Shin ichi Momomura, Yoshihisa Nakagawa, Yutaro Nishi, Yoshihiko Saito, Yasuhiro Satoh, Takahisa Yamada, Akira Yamashina, Satoshi Yasuda, Tsutomu Yoshikawa, Akiko Kada, Hiroyuki Uesaka, Masafumi Kitakaze

Research output: Contribution to journalArticlepeer-review

Abstract

Methods: EARLIER is an event-driven clinical trial with an estimated enrolment of 300 patients hospitalized with ADHF with reduced left ventricular ejection fraction. ADHF includes ischemic or non-ischemic HF, and patients can be enrolled within 72 h after the visit to the hospital. We randomize the patients taking standard therapies for ADHF to the eplerenone and placebo groups. Eplerenone, either 25 or 50 mg, is administered for 6 months in the eplerenone group, and the corresponding placebo is administered in the placebo group on top of the standard care. We set the primary endpoint as the incidence of the composite endpoint (cardiac death or first re-hospitalization due to cardiac disease) 6 months after the enrollment, and also check the quality of life, i.e., exercise capacity and safety features of eplerenone.

Background and Aims: Aldosterone is one of the major factors to cause organ damage during an acute phase of heart failure (HF), and many reports have demonstrated that patients with acute decompensated HF (ADHF) have high blood aldosterone concentrations, and the high aldosterone concentrations predict poor prognosis in patients with HF. These findings suggest that eplerenone, an antagonist of aldosterone receptors may provide a new concept and strategy for the treatment of ADHF, protecting the heart and other organs during chronic phases, depending on the restoration of hemodynamic abnormalities.

Conclusion and Perspectives: EARLIER is a clinical trial of eplerenone targeting ADHF and also the first multicenter investigator-initiated phase III trial in the cardiovascular field in Japan, funded by the Japanese government.

Original languageEnglish
Pages (from-to)179-185
Number of pages7
JournalCardiovascular Drugs and Therapy
Volume29
Issue number2
DOIs
Publication statusPublished - 2015 Apr 1
Externally publishedYes

Keywords

  • Acute heart failure
  • Acute myocardial infarction
  • Aldosterone
  • Cardiac death
  • Eplerenone
  • Re-hospitalization

ASJC Scopus subject areas

  • Pharmacology
  • Cardiology and Cardiovascular Medicine
  • Pharmacology (medical)

Fingerprint Dive into the research topics of 'Rationale and Design of the Double-Blind, Randomized, Placebo-Controlled Multicenter Trial on Efficacy of Early Initiation of Eplerenone Treatment in Patients with Acute Heart Failure (EARLIER)'. Together they form a unique fingerprint.

Cite this