Emerging treatments

Levosimendan

Levosimendan is an inodilator, meaning it provides inotropy with vasodilation. It has been licensed in Europe since the 2000s for the short-term treatment of acutely decompensated severe chronic heart failure when conventional therapy is not sufficient, and in cases where inotropic support is considered appropriate.[101] It is not approved for use in the US but remains under active clinical investigation.[101] Randomised controlled trials in adults have shown that levosimendan improves clinical outcomes and is generally well tolerated.[102][103] Evidence of levosimendan improving mortality versus other inodilators such as dobutamine remains conflicting.[104][105] Levosimendan has also demonstrated efficacy in the paediatric population with an acceptable safety profile. Results from a single-centre retrospective study suggested that levosimendan may reduce the need for mechanical circulatory support in children undergoing cardiac surgery or with decompensated heart failure.[106] Other studies have shown that levosimendan has similar efficacy to or is superior to milrinone in neonates and children.[107][108] Despite these findings, robust clinical trial evidence for levosimendan in paediatric patients remains lacking.[101] Levosimendan is being investigated for other indications including pulmonary hypertension and septic shock.[109] It failed to demonstrate superiority to placebo in patients with amyotrophic lateral sclerosis.[110]

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