[Nesiritide in heart failure: commercial success or therapeutic advance?]

Severe decompensated congestive heart failure unresponsive to conventional diuretic and vasodilator treatment is a clinical challenge. A new molecule, nesiritide or recombinant human BNP, has been recently successfully marketed in the U.S. due to its attractive physiologic effects. Unfortunately, the safety of nesiritide is now questioned based on two meta-analyses suggesting that nesiritide may be responsible for a worsening of renal function and an increased mortality. In the absence of further large scale studies with relevant endpoints, which are now unlikely to be conducted, nesiritide is rapidly disappearing from the therapeutic armamentarium.