VICTORIA Results to Headline ACC's First-Ever Virtual Meeting

March 15, 2020
Mary Caffrey

The big news at the American College of Cardiology meeting always comes early Saturday right after the opening showcase, and this year March 28 will bring the VICTORIA trial—or, a Vericiguat Global Study in Subjects With Heart Failure With Reduced Ejection Fraction (HFrEF).

The global COVID-19 pandemic may mean the largest annual meeting of cardiologists won’t happen in Chicago 2 weeks from now. But the science of the American College of Cardiology (ACC) 2020 will be shared just the same, thanks for a virtual format that will allow 23 late-breaking clinical trials, and a half-day intensive on cardio-obstetrics to address rising maternal mortality rates.

This year’s meeting, held in partnership with the World Congress of Cardiology, was set for Chicago from March 28 to 30, 2020. According to a briefing late Friday with Andrew M. Kates MD, FACC, meeting chair, and Pamela Morris, MD, FACC, vice chair, the schedule for late-breaking trials will adhere closely to the original timetable; findings that are being published in leading journals are embargoed and will be released throughout the weekend of the now-virtual meeting.

The American Journal of Managed Care® will present a comprehensive virtual meeting package starting March 19, 2020, with ACC’s consumer-focused studies. The package will feature deadline coverage of late-breaking science, interviews with scientists, and podcasts.

VICTORIA. The big news at ACC always comes early Saturday right after the opening showcase, and this year March 28 will bring the VICTORIA trial—or, a Vericiguat Global Study in Subjects With Heart Failure With Reduced Ejection Fraction (HFrEF). About 40% to 50% of patients with heart failure have HFrEF; of this group, 30% will see their heart failure worsen. Heart failure remains one of the most costly and debilitating conditions in the health system, so researchers continue to look for new therapies to prevent worsening of heart failure.

As Morris explained during the briefing Friday, patients with HFrEF can experience worsening of their heart failure even if they are receiving the most current standard of care. “The rising longevity of this population means we have to prioritize the search for new and novel heart failure therapies,” she said.

Vericiguat, a soluble guanylate cyclase (sGC) stimulator, addresses a new treatment mechanism, the nitric oxide-sGC pathway, which Morris said plays an important role in both normal cardiac and vascular function.

In November 2019, Merck and Bayer released topline results from the phase III study of more than 5000 patients with chronic heart failure, which showed vericiguat met its primary end point. Full results from the virtual meeting will illuminate the role of vericiguat in treating HFrEF in high-risk patients.

More Late-Breaking Science. The early session March 28 with the Journal of the American College of Cardiology also features VOYAGER-PAD, a global study of 6500 patients that examined whether adding rivaroxaban (Xarelto) to standard of care, vs placebo, can reduce the number of clinical events related to blood clots or major adverse events, or events in the legs, including amputation, among patients who had undergone recent procedures to improve blood flow. On March 29, the Caravaggio study will compare apixaban vs dalteparin for the treatment of acute venous thromboembolism (VTE) in patients with cancer and could shed light on management of VTE in these patients. On March 30, additional results from REDUCE-IT will examine eicosapentaenoic acid levels and cardiovascular outcomes, more than a year after the first results from this study stunned the research world.

Patients with HoFH. Morris recommended taking a look at results 2 studies involving patients with homozygous familial hypercholesterolemia (HoFH). The first is ODYSSEY HoFH, which will take a deeper dive into the effects of the PCSK9 inhibitor alirocumab (Praluent) on patients with this inherited condition that elevates low-density lipoprotein (LDL) cholesterol, making it hard to treat cholesterol even with statins or ezetimibe. A separate trial will report that evinacumab, an angiopoietin-like 3 antibody, significantly lowers low-density lipoprotein (LDL) cholesterol in HoFH patients. Due to the cost, payers balked at covering PCSK9 inhibitors when they were approved in 2015, even for patients with HoFH. It remains to be seen how payers will respond to evinacumab.

Other Findings of Note. Morris said there could be controversy from the Canadian study, “A Randomized Controlled Trial Evaluating The Efficacy And Safety Of E-Cigarettes For Smoking Cessation,” which will be presented March 30. And some of the most anticipated research results could come March 28, when ACC presents, “Practice Factors Affecting Cardiologists' Wellbeing: The American College Of Cardiology 2019 Well Being Study.”