Heart failure & cardiomyopathies
A Multicentre, Randomized, Double-Blind, Active and Placebo-Controlled Study of Pecavaptan, a Dual V1a/V2 Vasopressin Receptor Antagonist, in Patients with Acute Heart Failure: The AVANTI Trial
Authors' conclusion
Adjunctive pecavaptan for 30 days in patients with residual congestion had no impact on weight loss nor on renal function. Post-discharge pecavaptan monotherapy was non-inferior to furosemide monotherapy for weight change over 30 days, but was associated with improved renal function.
Study context
- Population
- Patients hospitalised with HF and residual congestion483 Part A
- Comparison
- Pecavaptan vs placebo and pecavaptan vs furosemide
- Primary endpoint
- Part A: change in weight and serum creatinine; Part B: change in weight and blood urea nitrogen/creatinine ratio (co-primary)
- Follow-up
- 30 days
Methodological detailsdouble-blind, multicentre, active and placebo-controlled, two parts (A: adjunctive; B: replacement), non-inferiority (Part B weight)
- Double-blind
- Multicentre
- Active and placebo-controlled
- Two parts (A: adjunctive; B: replacement)
- Non-inferiority (Part B weight)
Primary result
As reported in the abstract
Co-primary endpoints: Part A weight and serum creatinine change; Part B weight and BUN/creatinine ratio change
- Pecavaptan vs Placebo · Part A, weight change
- between-group difference −0.27 kg (one-sided 95% CI upper −0.29); P = 0.21
- Pecavaptan vs Placebo · Part A, serum creatinine change
- between-group difference 0.05 mg/dl (one-sided 95% CI upper 0.12); P = 0.87
- Pecavaptan vs Furosemide · Part B, weight change; non-inferiority criteria of 1 kg satisfied
- difference 0.69 kg (one-sided 80% CI upper 0.95); P = 0.16
- Pecavaptan vs Furosemide · Part B, log-transformed change in BUN/creatinine ratio; favouring pecavaptan
- between-group difference −0.22 (one-sided 80% CI upper −0.19); P < 0.0001
Safety
AEs and serious AEs related to congestion incl. HF hospitalisations
- Numerically higher with pecavaptan in both parts
Original publication
A Multicentre, Randomized, Double-Blind, Active and Placebo-Controlled Study of Pecavaptan, a Dual V1a/V2 Vasopressin Receptor Antagonist, in Patients with Acute Heart Failure: The AVANTI Trial. Eur J Heart Fail. Published 11 August 2025. doi:10.
Summarised from the published abstract; every number is checked against it