Drug Therapy

AVP receptor antagonists have been successfully applied in experimental congestive heart failure,Ref-45, Ref-72 and hyponatremia,73 but first clinical trials report mixed results in heart failure therapy, with no effect on mortality.Ref-54-55 Knowledge of copeptin plasma concentrations may be important for the introduction of such novel therapies, as it follows simple reasoning that it is of value to know the level of the circulating substance that one intends to block by a specific therapy. Future studies should evaluate whether treatment with AVP receptor antagonists is most effective if the vasopressinergic system is activated, as can now easily be assessed by copeptin plasma concentrations. Measurement of copeptin levels may be useful in determining whether AVP receptor antagonist therapy is not only appropriate in patients with chronic heart failure and hyponatremia, but also in patients with other diseases, such as cirrhosisRef-74 or renal failure,Ref-65-67 in which AVP has been shown to play a pathophysiologic role.

Furthermore, since AVP receptor antagonists may be ineffective in up to 30% of patients, it needs to be examined if this lack of effect is related to the level of circulating AVP. Copeptin measurements could help in this assessment.


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