Cargando…

Beneficial and harmful effects of sacubitril/valsartan in patients with heart failure: a systematic review of randomised clinical trials with meta-analysis and trial sequential analysis

Current guidelines recommend angiotensin receptor blocker neprilysin inhibitors (ARNI) (sacubitril/valsartan) as a replacement for angiotensin-converting-enzymeinhibitor (ACE-I) in heart failure with reduced ejection fraction (HFrEF) who remain symptomatic despite optimal medical therapy. The effect...

Descripción completa

Detalles Bibliográficos
Autores principales: Nielsen, Emil Eik, Feinberg, Joshua Buron, Bu, Fan-Long, Hecht Olsen, Michael, Raymond, Ilan, Steensgaard-Hansen, Frank, Jakobsen, Janus Christian
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7705560/
https://www.ncbi.nlm.nih.gov/pubmed/33257469
http://dx.doi.org/10.1136/openhrt-2020-001294
_version_ 1783616974437220352
author Nielsen, Emil Eik
Feinberg, Joshua Buron
Bu, Fan-Long
Hecht Olsen, Michael
Raymond, Ilan
Steensgaard-Hansen, Frank
Jakobsen, Janus Christian
author_facet Nielsen, Emil Eik
Feinberg, Joshua Buron
Bu, Fan-Long
Hecht Olsen, Michael
Raymond, Ilan
Steensgaard-Hansen, Frank
Jakobsen, Janus Christian
author_sort Nielsen, Emil Eik
collection PubMed
description Current guidelines recommend angiotensin receptor blocker neprilysin inhibitors (ARNI) (sacubitril/valsartan) as a replacement for angiotensin-converting-enzymeinhibitor (ACE-I) in heart failure with reduced ejection fraction (HFrEF) who remain symptomatic despite optimal medical therapy. The effects of ARNIs have not previously been assessed in a systematic review. We searched for relevant trials until October 2019 in CENTRAL, MEDLINE, Embase, LILACS, BIOSIS, CNKI, VIP, WanFang and CBM. Our primary outcomes were all-cause mortality and serious adverse events. We systematically assessed the risks of random errors and systematic errors. PROSPERO registration: CRD42019129336. 48 trials randomising 19 086 participants were included. The ARNI assessed in all trials was sacubitril/valsartan. ACE-I or ARB were used as control interventions. Trials randomising HFrEF participants (27 trials) and heart failure with preserved ejection fraction (HFpEF) participants (four trials) were analysed separately. In HFrEF participants, meta-analyses and Trial Sequential Analyses showed evidence of a beneficial effect of sacubitril/valsartan when assessing all-cause mortality (risk ratio (RR), 0.86; 95% CI, 0.79 to 0.94) and serious adverse events (RR, 0.89; 95% CI, 0.86 to 0.93); and the results did not differ between the guideline recommended target population and HFrEF participants in general. We found no evidence of an effect of sacubitril/valsartan in HFpEF participants. Sacubitril/valsartan compared with either ACE-I or ARB seems to have a beneficial effect in patients with HFrEF. Our results indicate that sacubitril/valsartan might be beneficial in a wider population of patients with heart failure than the guideline recommended target population. Sacubitril/valsartan does not seem to show evidence of a difference compared with valsartan in patients with HFpEF.
format Online
Article
Text
id pubmed-7705560
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher BMJ Publishing Group
record_format MEDLINE/PubMed
spelling pubmed-77055602020-12-09 Beneficial and harmful effects of sacubitril/valsartan in patients with heart failure: a systematic review of randomised clinical trials with meta-analysis and trial sequential analysis Nielsen, Emil Eik Feinberg, Joshua Buron Bu, Fan-Long Hecht Olsen, Michael Raymond, Ilan Steensgaard-Hansen, Frank Jakobsen, Janus Christian Open Heart Heart Failure and Cardiomyopathies Current guidelines recommend angiotensin receptor blocker neprilysin inhibitors (ARNI) (sacubitril/valsartan) as a replacement for angiotensin-converting-enzymeinhibitor (ACE-I) in heart failure with reduced ejection fraction (HFrEF) who remain symptomatic despite optimal medical therapy. The effects of ARNIs have not previously been assessed in a systematic review. We searched for relevant trials until October 2019 in CENTRAL, MEDLINE, Embase, LILACS, BIOSIS, CNKI, VIP, WanFang and CBM. Our primary outcomes were all-cause mortality and serious adverse events. We systematically assessed the risks of random errors and systematic errors. PROSPERO registration: CRD42019129336. 48 trials randomising 19 086 participants were included. The ARNI assessed in all trials was sacubitril/valsartan. ACE-I or ARB were used as control interventions. Trials randomising HFrEF participants (27 trials) and heart failure with preserved ejection fraction (HFpEF) participants (four trials) were analysed separately. In HFrEF participants, meta-analyses and Trial Sequential Analyses showed evidence of a beneficial effect of sacubitril/valsartan when assessing all-cause mortality (risk ratio (RR), 0.86; 95% CI, 0.79 to 0.94) and serious adverse events (RR, 0.89; 95% CI, 0.86 to 0.93); and the results did not differ between the guideline recommended target population and HFrEF participants in general. We found no evidence of an effect of sacubitril/valsartan in HFpEF participants. Sacubitril/valsartan compared with either ACE-I or ARB seems to have a beneficial effect in patients with HFrEF. Our results indicate that sacubitril/valsartan might be beneficial in a wider population of patients with heart failure than the guideline recommended target population. Sacubitril/valsartan does not seem to show evidence of a difference compared with valsartan in patients with HFpEF. BMJ Publishing Group 2020-11-30 /pmc/articles/PMC7705560/ /pubmed/33257469 http://dx.doi.org/10.1136/openhrt-2020-001294 Text en © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/ http://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
spellingShingle Heart Failure and Cardiomyopathies
Nielsen, Emil Eik
Feinberg, Joshua Buron
Bu, Fan-Long
Hecht Olsen, Michael
Raymond, Ilan
Steensgaard-Hansen, Frank
Jakobsen, Janus Christian
Beneficial and harmful effects of sacubitril/valsartan in patients with heart failure: a systematic review of randomised clinical trials with meta-analysis and trial sequential analysis
title Beneficial and harmful effects of sacubitril/valsartan in patients with heart failure: a systematic review of randomised clinical trials with meta-analysis and trial sequential analysis
title_full Beneficial and harmful effects of sacubitril/valsartan in patients with heart failure: a systematic review of randomised clinical trials with meta-analysis and trial sequential analysis
title_fullStr Beneficial and harmful effects of sacubitril/valsartan in patients with heart failure: a systematic review of randomised clinical trials with meta-analysis and trial sequential analysis
title_full_unstemmed Beneficial and harmful effects of sacubitril/valsartan in patients with heart failure: a systematic review of randomised clinical trials with meta-analysis and trial sequential analysis
title_short Beneficial and harmful effects of sacubitril/valsartan in patients with heart failure: a systematic review of randomised clinical trials with meta-analysis and trial sequential analysis
title_sort beneficial and harmful effects of sacubitril/valsartan in patients with heart failure: a systematic review of randomised clinical trials with meta-analysis and trial sequential analysis
topic Heart Failure and Cardiomyopathies
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7705560/
https://www.ncbi.nlm.nih.gov/pubmed/33257469
http://dx.doi.org/10.1136/openhrt-2020-001294
work_keys_str_mv AT nielsenemileik beneficialandharmfuleffectsofsacubitrilvalsartaninpatientswithheartfailureasystematicreviewofrandomisedclinicaltrialswithmetaanalysisandtrialsequentialanalysis
AT feinbergjoshuaburon beneficialandharmfuleffectsofsacubitrilvalsartaninpatientswithheartfailureasystematicreviewofrandomisedclinicaltrialswithmetaanalysisandtrialsequentialanalysis
AT bufanlong beneficialandharmfuleffectsofsacubitrilvalsartaninpatientswithheartfailureasystematicreviewofrandomisedclinicaltrialswithmetaanalysisandtrialsequentialanalysis
AT hechtolsenmichael beneficialandharmfuleffectsofsacubitrilvalsartaninpatientswithheartfailureasystematicreviewofrandomisedclinicaltrialswithmetaanalysisandtrialsequentialanalysis
AT raymondilan beneficialandharmfuleffectsofsacubitrilvalsartaninpatientswithheartfailureasystematicreviewofrandomisedclinicaltrialswithmetaanalysisandtrialsequentialanalysis
AT steensgaardhansenfrank beneficialandharmfuleffectsofsacubitrilvalsartaninpatientswithheartfailureasystematicreviewofrandomisedclinicaltrialswithmetaanalysisandtrialsequentialanalysis
AT jakobsenjanuschristian beneficialandharmfuleffectsofsacubitrilvalsartaninpatientswithheartfailureasystematicreviewofrandomisedclinicaltrialswithmetaanalysisandtrialsequentialanalysis