The aim of the Houchen et al. study was to compare real-world outcomes of Entresto® (sacubitril/valsartan) vs. angiotensin converting enzyme inhibitor (ACEi) or angiotensin receptor blocker (ARB) therapy, in RAASi-naïve patients with HF and reduced ejection fraction (HFrEF).1 The outcomes showed that fewer patients with HFrEF initiating treatment with sacubitril/valsartan were re-hospitalised compared with patients treated with ACEi/ARB.1

 

Methods

This retrospective cohort study included de-identified data on RAASi-naïve patients in US with HFrEF (left ventricular ejection fraction ≤ 40%), who had newly initiated Entresto® or ACEi/ARB.1 New sacubitril/valsartan users were propensity score matched 1:2 with new ACEi/ARB users, by pre-selected characteristics using a greedy many-to-one algorithm to account for potential bias and confounding.1 

  • The primary endpoint was the rate of HF hospitalisations for both new sacubitril/valsartan users and new ACEi/ARB users during the post-index period.1 
  • Secondary endpoints included the rate of the composite of HF hospitalisation or emergency room (ER) visits, rate of all-cause hospitalisations, rate of cardiovascular hospitalisations, time to first HF hospitalisation, time to first HF hospitalisation or ER visit, and time to first all-cause hospitalisation for new sacubitril/valsartan users and new ACEi/ARB users during the post-index period.1

Results

After propensity score matching, there were 3059 patients in the sacubitril/valsartan cohort and 6118 patients in the ACEi/ARB cohort, with no significant differences between the two cohorts for any of the baseline characteristics, except the proportion of patients with sleep apnea, which was higher in the sacubitril/valsartan cohort (18.2 vs. 16.4%; P = 0.03).1

All-cause hospitalisation: 
13% lower rate for new sacubitril/valsartan users compared with new ACEi/ARB users (68.11 per 100 PYs vs. 80.17 per 100 PYs; IRR 0.87; 95% CI 0.81–0.93; P < 0.0001).

Composite of HF hospitalisation or ER visits:
13% lower rate for new sacubitril/valsartan users compared with new ACEi/ARB users (73.38 per 100 PYs vs. 88.34 per 100 PYs; IRR 0.87; 95% CI 0.81–0.94; P = 0.00023). 

Cardiovascular hospitalisations:
Similar rates between the two cohorts (46.29 per 100 PYs vs. 50.40 per 100 PYs; IRR 0.94; 95% CI 0.87–1.02; P = 0.14).1 

Time-to-event analysis: 
New sacubitril/valsartan users had a significantly lower risk of first HF hospitalisation or ER visit (HR 0.92; 95% CI 0.86–0.98; P = 0.01) and first all-cause hospitalisation (HR 0.85; 95% CI 0.80–0.91; P=0.0001), compared with new ACEi/ARB users.1


Conclusion

The study showed that the use of sacubitril/valsartan in RAASi-naïve patients with HFrEF resulted in significantly lower rates of all-cause hospitalisation and the composite of HF hospitalisation or ER visits compared with ACEi/ARB treatment.1 The rates of HF and cardiovascular hospitalisations were similar between the two cohorts. Real-world clinical practice suggests when initiating sacubitril/valsartan directly in RAASi-naïve patients with HFrEF it can reduce total hospitalisations.1


Referenser
  1. Houchen E et al. Hospitalization Rates in Patients with Heart Failure and Reduced Ejection Fraction Initiating Sacubitril/Valsartan or Angiotensin-Converting Enzyme Inhibitors/Angiotensin Receptor Blockers: A Retrospective Cohort Study. Cardiol Ther. 2022;11(1):113-127
 
ENTRESTO® (sakubitril/valsartan) Rx. (F) Subvention endast enligt indikation. ATC kod C09DX04. Beredningsform: Filmdragerade tabletter. ENTRESTO hämmar neprilysin (via sakubitril) samtidigt som den blockerar AT1 receptorn (via valsartan). Indikation: Behandling av kronisk symtomatisk hjärtsvikt hos vuxna med nedsatt ejektionsfraktion. Kontraindikationer: Överkänslighet mot de aktiva substanserna eller något hjälpämne. ENTRESTO får inte administreras förrän tidigast 36 timmar efter avbruten behandling med ACE-hämmare. Tidigare konstaterat, ärftligt eller idiopatiskt angioödem. Samtidig användning med aliskireninnehållande läkemedel hos patienter med diabetes mellitus eller patienter med nedsatt njurfunktion. Allvarligt nedsatt leverfunktion, biliär cirros och kolestas. Andra och tredje trimestern av graviditet. Varningar och försiktighet: Dubbel blockad av renin-angiotensin-aldosteronsystemet. SBP<100 mm Hg. Hyperkalemi. Nedsatt njurfunktion. Måttligt nedsatt leverfunktion. ENTRESTO har mindre effekt på förmågan att framföra fordon och andra maskiner. För pris och ytterligare information se www.fass.se. Datum för senaste översynen av produktresumén: 2022-09-02. Novartis Sverige AB, Telefon 08-732 32 00, www.novartis.se.
Betygsätt sidan
SE2211081723 (8 november 2022)
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