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Furosemide Injection (Furoscix) for Subcutaneous Use Treating Coronary heart Failure

by ZeroToHero

Background

Coronary heart failure impacts greater than 6 million US adults and is estimated to contribute $30.7 billion in well being care prices, with this quantity anticipated to at the very least double by 2030.1 A majority of those prices could be attributed to hospital admissions, which is compounded by related oblique prices, equivalent to absenteeism, bodily limitations, and illness burden.

In an effort to restrict hospitalizations, and thus coronary heart failure-related well being care prices, subcutaneous (SC) furosemide (Furoscix) was developed as a substitute for intravenous (IV) diuretic remedy. By utilizing an on-body supply system, the topic can obtain parenteral furosemide by way of the SC route with out being in a hospital setting.

Indication

In October 2022, scPharmaceuticals Inc. obtained FDA approval forFuroscix, the primary self-administered, SC loop diuretic. Furoscixis indicated to deal with congestion attributable to fluid overload in sufferers with NYHA Class II/III continual coronary heart failure.2

Mechanism of Motion

Furosemide displays diuretic motion by inhibiting sodium and chloride reabsorption within the proximal and distal tubules and the loop of Henle. When administered SC, the bioavailability is maintained (F = 99.6%), producing related results as IV administration.2

Dosing and Administration

Furoscixis administered by way of an on-body supply system pre-programmed to ship 80 mg of furosemide subcutaneously greater than 5 hours. The system makes use of bi-phasic supply, with 30 mg delivered over the primary hour, adopted by 12.5 mg per hour for 4 hours. The infusion timing was developed to imitate IV administration of two 40 mg bolus doses separated by 2 hours.2

Dose Changes

The supply system is preprogrammed; due to this fact, the dose can’t be adjusted.2

Contraindications

Anuria, hypersensitivity to furosemide or medical adhesives, hepatic cirrhosis, or ascites.2

Frequent Opposed Results

Infusion website reactions (bruising, hemorrhage, ache), urinary tract an infection, muscle spasms, and dizziness.2

Efficacy

Financial affect was assessed primarily based on the preliminary outcomes from the FREEDOM-HF trial, a part 3, non-randomized, propensity-matched, medical trial.3

Major Final result

Distinction in total and coronary heart failure-related well being care prices between the Furoscix Infusor and the propensity-matched (remedy as regular) management:

  • 95% CI (-22187.9 to -11082.7), p<0.0001
  • The distinction in well being care prices was statistically vital.
  • The Furoscix Infusor related to $16,995.30 much less coronary heart failure-related prices and $27,840.50 much less total well being care prices in comparison with the management arm.

Secondary Outcomes

Hospital admissions at 30 days:

  • p=0.5856
  • There was no statistically vital distinction in hospital admissions, with the Furoscix Infusor group having 5.3% extra hospital admissions than the management.

Coronary heart failure-related emergency division (ED) visits at 30 days:

  • p=1
  • There was no statistically vital distinction in ED visits, with the Furoscix Infusor group having 1.9% much less ED visits than the management arm.

Well being-related high quality of life measured by the self-reported Kansas Metropolis Cardiomyopathy Questionnaire (KCCQ) at 30 days:

  • 95% CI (0.4 to 25.3), p=0.0443
  • The distinction in KCCQ scores was statistically vital, with the Furoscix Infusor arm averaging 12.8 extra factors than the management arm, reflecting a greater high quality of life.

Concerning the Writer

Abby Leitch, PharmD candidate 2023, College of Minnesota.

Preceptor

Chelsea Morken, PharmD, PGY2 ambulatory care pharmacy resident, Mayo Clinic Well being System – Mankato.

References

  1. Patel J. Coronary heart Failure Inhabitants Well being Concerns. Am J Manag Care 2021; 27(suppl 9):S191-195.
  2. Product Data: Furoscix, furosemide injection. [package insert]. scPharmaceuticals, Inc., Burlington, MA, 2022.
  3. scPharmaceuticals, Inc. (2020, November 12 – 2021, June 24). Furoscix Actual-World Analysis for Lowering Hospital Admissions in Coronary heart Failure (FREEDOM-HF). Identifier NCT03458325. https://clinicaltrials.gov/ct2/present/research/NCT03458325