A new tool to enhance smell recovery?
Reviewed by Joanna Stephens

Vericiguat is a soluble guanylate cyclase activator which boosts intracellular cGMP and promotes smooth muscle relaxation. It is approved for use in heart failure, but the authors hypothesise that it may also enhance neuronal olfactory signalling via cGMP elevation. Eighty-eight patients with functional anosmia on Sniffin Sticks testing (TDI of <16.5), following an URTI, were randomised into a placebo group and an oral Vericiguat group. The patients were treated for 12 months with the placebo, (identical size and shape to the treatment) or 4 mg of Vericiguat, and were assessed with Sniffin Sticks olfactory testing multiple times during the study period.In all three criteria of threshold, discrimination and identification, Vericiguat out-performed the placebo group which showed no improvement in TDI scores across all three outcome measures. The degree of improvement increased with time over the 12-month period, reaching statistical significance by month 12 (T), month 10 (D) and month 6 (I). However, the total improvement in TDI was 3.19 points and this did not reach the clinically relevant threshold set at 5.5 point improvement in TDI. This is an interesting study, although it failed to demonstrate a significant improvement in smell function, and it is likely that the patients perceived little clinical benefit with this modest improvement in TDI scores. I would like to see how the addition of smell training, which is the most evaluated and most successful intervention for olfactory loss to date, would change the clinical benefit.

Vericiguat enhances olfactory function in post infectious anosmia: a randomised pilot double-blind placebo-controlled trial.
Alharbi A, Abdelazim MH, Alshammari AS, et al. 
AM J RHINOL ALLERGY
2025;39(6):416–24.