January 25, 2011

Dear Medical Staff:

Subject:  Natrecor® (nesiritide) Formulary Status

Natrecor usage was once again reviewed at the December Pharmacy and Therapeutics Committee.

The results of the long awaited Ascend-HF trial were presented.  This trial looked at more than 7,000 acutely decompensated heart failure patients randomly assigned to receive either nesiritide or placebo for 24-168 hours in addition to standard care.  The key results of the study:

·        Dyspnea at 6 hours, 44.5% of nesiritide patients had improvements in breathing compared to 42.1% of placebo.

·        Dyspnea at 24 hours, 68.2% of nesiritide patients had improvements in breathing compared to 66.1% of placebo.

·        No significant impact on 30-day mortality from any cause or heart failure rehospitalization compared with placebo 9.4% versus 10.1%.

Although small improvements in dyspnea were noted in the Natrecor® group, no statistically significant impact on mortality was noted.  Overall, it was the consensus of the committee that the drug did not improve the outcome of patients with acute decompensated heart failure who are receiving excellent standard of care medicine.

It was the decision of the group to remove Natrecor® from Memorial Health Care System Drug Formulary due to the significant cost vs. minimal benefit as observed in this trial.

If you wish to discuss this further with the committee, please feel free to attend a future meeting and present your views.

Sincerely,

Richard Pesce, M.D.

Chairman of the Pharmacy and Therapeutics Committee

Memorial Health Care System