Mortality and Heart Failure Risk Reductions in Patients Treated with Sacubitril-Valsartan in Clinical Trials
Background: The angiotensin receptor neprilysin inhibitor sacubitril-valsartan is included in the first-line treatment for patients with heart failure (HF) and left ventricle ejection fraction (LVEF). Three clinical trials have evaluated the effect of sacubitril-valsartan in 3 different clinical settings, although all included patients at high-risk of mortality or HF hospitalization. Nonetheless, only the PARADIGM-HF trial demonstrated a significant benefit with sacubitril-valsartan.Methods: We performed a metanalysis with the 3 currently available trials to assess the effect of sacubitril-valsartan on mortality and HF hospitalizations.Results: A total of 18,856 were analyzed: 9,424 treated with sacubitril-valsartan and 9,432 in the conventional treatment arm (7,043 with valsartan and 2,389 with ramipril). Sacubitril-valsartan treatment reduced all-cause mortality in 11% (HR: 0.89 95% CI 0.83-0.95; p=0.001), cardiovascular in 15% (HR: 0.85 95% CI 0.78-0.92; p=0.001) and HF hospitalizations by 16% (HR: 0.84 95% CI 0.79-0.90; p<0.001). No heterogeneity or small-study effect were observed in any of the endpoints. We also assessed the effect of sacubitril-valsartan according to the subgroups of LVEF reported in each trial (5,767 patients (30.6%) had LVEF >40%) and no correlation (p=0.937) was observed between baseline LVEF and treatment effect on the primary end-point.Conclusions: Despite the wide range of clinical scenarios where treatment with sacubitril-valsartan has been tested, it efficiently reduces mortality and HF hospitalizations.Funding Statement: Investigators received the support of the Centro de Investigación Biomédica enRed de Enfermedades Cardiovasculares (CIBERCV) Spain, the National Network for Biomedical Research in Cardiovascular Disease.Declaration of Interests: - Alberto Cordero reports a) honoraria for lectures from AstraZeneca, Bristol- Myers Squibb, Ferrer, Boehringer Ingelheim, MSD, and Bristol-Myers Squibb and AMGEN; b) consulting fees from AstraZeneca, Ferrer and AMGEN. - Julio Nuñez reports a) honoraria for lectures from AstraZeneca, Boehringer Ingelheim, Eli Lilly Co, Novartis, and Rovi; b) consulting fees from AstraZeneca, Boehringer Ingelheim, Bayer, and Novartis - Lorenzo Fácila reports a) honoraria for lectures from Eli Lilly Co, Daiichi Sankyo, Inc., Bayer, Pfizer, Novartis Boehringer Ingelheim b) consulting fees from AstraZeneca, Boehringer, Bayer - María Amparo Quintanilla reports a) honoraria for lectures from Astra Zeneca, Boehringer Ingelheim, Eli Lilly, and Rovi; b) consulting fees from Boehringer Ingelheim, Eli Lilly and AstraZeneca - Vicente Bertomeu-González reports a) honoraria for lectures from Daiichi Sankyo, Boehringer Ingelheim, Bayer, Pfizer-BMS, LivaNova, Ferrer, Cardiome, MSD; b) consulting fees none; c) research grants from Medtronic Iberica. - Moisés Rodríguez-Mañero report research grants from Fundación Mutua Madrileña, Biosense Webseter, Medtronic and from the Carlos III Institute of Health, Ministry of Economy and Competitiveness (Spain). - Javier Torres Llergo reports a) lecture honoraria from AstraZeneca, Bayer, Boehringer-Ingelheim, Pfizer-BMS, Rovi, Eli Lilly, Novartis and Vifor ; b) consulting fees from AstraZeneca, Boehringer, Novartis. - Antoni Bayes-Genís reports lecture honoraria from Abbott, AstraZeneca, Boehringer-Ingelheim, Novartis, Vifor, Roche Diagnostics, and Critical Diagnostics. - José Ramón González-Juanatey reports a) honoraria for lectures from Eli Lilly Co, Daiichi Sankyo, Inc., Bayer, Pfizer, Abbott, Boehringer Ingelheim, MSD, Ferrer, and Bristol-Myers Squibb; b) consulting fees from AstraZeneca, Ferrer, Bayer, Boehringer-Ingelheim; c) research grants from AstraZeneca, Boehringer- Ingelheim and Daichii-Saunkyo
Year of publication: |
[2022]
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Authors: | Cordero, Alberto ; Nuñez, Julio ; Bertomeu-González, Vicente ; Fácila, Lorenzo ; Quintanilla, Mª Amparo ; Rodríguez-Mañero, Moisés ; Valle, Alfonso ; de la Espriella, Rafael ; Torres Llergo, Javier ; Bayes-Genis, Antoni ; Gonzalez Juanatey, Jose Ramon |
Publisher: |
[S.l.] : SSRN |
Subject: | Sterblichkeit | Mortality | Krankenhaus | Hospital | Arzneimittel | Pharmaceuticals | Patienten | Patients | Herzkrankheit | Heart disease |
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