Combined neprilysin and renin-angiotensin system inhibition in heart failure with reduced ejection fraction: A meta-analysis
Journal article
Solomon, Scott D., Claggett, Brian L., McMurray, John J. V., Hernandez, Adrian F. and Fonarow, Gregg C.. (2016). Combined neprilysin and renin-angiotensin system inhibition in heart failure with reduced ejection fraction: A meta-analysis. European Journal of Heart Failure. 18(10), pp. 1238 - 1243. https://doi.org/10.1002/ejhf.603
Authors | Solomon, Scott D., Claggett, Brian L., McMurray, John J. V., Hernandez, Adrian F. and Fonarow, Gregg C. |
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Abstract | Aims: The combined neprilysin/renin–angiotensin system (RAS) inhibitor sacubitril/valsartan reduced cardiovascular death or heart failure hospitalization, cardiovascular death, and all-cause mortality in a large outcomes trial. While sacubitril/valsartan is the only currently available drug in its class, there are two prior clinical trials in heart failure with omapatrilat, another combined neprilysin/RAS inhibitor. Using all available evidence can inform clinicians and policy-makers. Methods and results: We performed a meta-analysis using data from three trials in heart failure with reduced EF that compared combined neprilysin/RAS inhibition with RAS inhibition alone and reported clinical outcomes: IMPRESS (n = 573), OVERTURE (n = 5770), and PARADIGM-HF (n = 8399). We assessed the pooled hazard ratio (HR) for all-cause death or heart failure hospitalization, and for all-cause mortality in random-effects models, comparing combined neprilysin/RAS inhibition with ACE inhibition alone. The composite outcome of death or heart failure hospitalization was reduced numerically in patients receiving combined neprilysin/RAS inhibition in all three trials, with a pooled HR of 0.86, 95% confidence interval (CI) 0.76–0.97, P = 0.013. For the endpoint of all-cause mortality, the pooled HR was 0.88, 95% CI 0.80–0.98, P = 0.021. Combined neprilysin/RAS inhibition compared with ACE inhibition was associated with more hypotension, but less renal dysfunction and hyperkalaemia in all three trials. Conclusions: Pooled estimates from three trials with two separate drugs of combined neprilysin/RAS inhibition support the use of combined neprilysin/RAS inhibition in heart failure with reduced EF. |
Keywords | heart failure; neprilysin; renin–angiotensin system; meta-analysis |
Year | 2016 |
Journal | European Journal of Heart Failure |
Journal citation | 18 (10), pp. 1238 - 1243 |
Publisher | John Wiley & Sons Ltd |
ISSN | 1388-9842 |
Digital Object Identifier (DOI) | https://doi.org/10.1002/ejhf.603 |
Scopus EID | 2-s2.0-84989872584 |
Page range | 1238 - 1243 |
Research Group | Mary MacKillop Institute for Health Research |
Publisher's version | File Access Level Controlled |
Place of publication | United Kingdom |
https://acuresearchbank.acu.edu.au/item/88z7z/combined-neprilysin-and-renin-angiotensin-system-inhibition-in-heart-failure-with-reduced-ejection-fraction-a-meta-analysis
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