Benefits and Harms of Sacubitril in Adults With Heart Failure and Reduced Left Ventricular Ejection Fraction.

Abstract

The quality of evidence regarding patient-centered outcomes in adults with heart failure (HF) after sacubitril combined with valsartan has not been systematically appraised. We searched 4 databases in February 2017 and graded the quality of evidence according to the Grading of Recommendations Assessment, Development and Evaluation working group approach. We reviewed 1 meta-analysis and multiple publications of 2 randomized controlled trials (RCT) and 1 unpublished RCT. In adults with HF and reduced ejection fraction, low-quality evidence from 1 RCT of 8,432 patients suggests that sacubitril combined with valsartan reduces all-cause (number needed to treat [NNT] to prevent 1 event [NNTp] = 35) and cardiovascular mortality (NNTp = 32), hospitalization (NNTp = 11), emergency visits (NNTp = 69), and serious adverse effects, leading to treatment discontinuation (NNTp = 63) and improves quality of life when compared with enalapril. In adults with HF and preserved ejection fraction, very low-quality evidence from 1 RCT of 301 patients suggests that there are no differences in mortality, morbidity, or adverse effects between sacubitril combined with valsartan and valsartan alone. In conclusion, in adults with HF and reduced ejection fraction, to reduce cardiovascular mortality and hospitalizations and improve quality of life, clinicians may recommend sacubitril combined with valsartan over angiotensin-converting enzyme inhibitors.

• Authors: Wilbert S Aronow, Tatyana A Shamliyan
• Journal: The American journal of cardiology (Am J Cardiol) Vol. 120 Issue 7 Pg. 1166-1170 (Oct 01 2017) ISSN: 1879-1913 [Electronic] United States
• PMID: 28800834 (Publication Type: Journal Article, Review)
• Copyright: Copyright © 2017 Elsevier Inc. All rights reserved.

Chemical References

• Aminobutyrates
• Angiotensin Receptor Antagonists
• Biphenyl Compounds
• Drug Combinations
• Tetrazoles
• Valsartan
• sacubitril and valsartan sodium hydrate drug combination

Topics

• Adult
• Aminobutyrates (pharmacology)
• Angiotensin Receptor Antagonists (pharmacology)
• Biphenyl Compounds
• Drug Combinations
• Heart Failure (drug therapy, physiopathology)
• Humans
• Stroke Volume (drug effects, physiology)
• Tetrazoles (pharmacology)
• Treatment Outcome
• Valsartan
• Ventricular Function, Left (physiology)