Medicine · Pharmacology

First-in-class drug for HF approved?

?PHARMACOLOGY UPDATE:

?First-in-class drug for HF approved?: Time to replace ACE inhibitors

?Approval of the first angiotensin-receptor/neprilysin inhibitor (ARNI): valsartan/sacubitril for the treatment of heart failure with reduced ejection fraction (HFrEF)

?PARADIGM-HF* trial results last year which showed that valsartan/sacubitril (formerly called LCZ696) significantly reduced the risk of cardiovascular (CV) death and hospitalization for HF compared with the ACE inhibitor enalapril.

?[N Engl J Med2014; 371:993-1004]

?PARADIGM-HF was halted early in March, after a median follow-up of 27 months, because patients taking LCZ696 achieved a statistically significant reduction in CV deaths and HF hospitalizations despite being on beta-blockers and a diuretic.

?Cardiologists considered this a major step forward since only a few therapies have shown mortality reduction in HF or in other CV conditions.

?Given the increasing morbidity in HF, hospitalizations, and cost of care, any new therapy that has an added benefit to – or is better than – ACE inhibitors is a potential game-changer

?The FDA said valsartan/sacubitril should not be used with any ACE inhibitor because of increased risk of angioedema

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