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Benefits and adverse effects of sacubitril/valsartan in patients with chronic heart failure: A systematic review and meta‐analysis
This review aims to assess the benefits and adverse effects of sacubitril/valsartan in heart failure, with a focus on important patient outcomes. A systematic review was conducted of double‐blind randomized controlled trials (RCTs) comparing sacubitril/valsartan versus a reference drug, in heart fai...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8495680/ https://www.ncbi.nlm.nih.gov/pubmed/34617669 http://dx.doi.org/10.1002/prp2.844 |
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author | Charuel, Elodie Menini, Thibault Bedhomme, Sabrina Pereira, Bruno Piñol‐Domenech, Nathalie Bouchant, Suzy Boussageon, Rémy Bœuf‐Gibot, Sylvaine Vaillant‐Roussel, Helene |
author_facet | Charuel, Elodie Menini, Thibault Bedhomme, Sabrina Pereira, Bruno Piñol‐Domenech, Nathalie Bouchant, Suzy Boussageon, Rémy Bœuf‐Gibot, Sylvaine Vaillant‐Roussel, Helene |
author_sort | Charuel, Elodie |
collection | PubMed |
description | This review aims to assess the benefits and adverse effects of sacubitril/valsartan in heart failure, with a focus on important patient outcomes. A systematic review was conducted of double‐blind randomized controlled trials (RCTs) comparing sacubitril/valsartan versus a reference drug, in heart failure patients with reduced (HFrEF) and preserved (HFpEF) ejection fraction, published in French or English. Searches were undertaken of Medline, Cochrane Central, and Embase. The primary outcomes were all‐cause mortality and adverse events. From 2 082 articles analyzed, 5 were included. For all‐cause mortality, the absolute numbers for HFrEF (2 RCTs, 4627 patients) were 16% on sacubitril/valsartan and 18% on enalapril, with a risk ratio (RR) of 0.85 [CI = 0.78, 0.93], and 13% vs 14% in with HFpEF (2 RCTs, 5097 patients), with no statistical difference. Under the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, the evidence for HFrEF patients was of moderate quality. For HFrEF patients, an increased risk of symptomatic hypotension and angioedema (low quality of evidence) was shown. There was no statistical difference for the risk of hyperkalemia or worsening renal function. There was a protective RR (0.50 [0.34, 0.75]) for worsening renal function for patients with HFpEF, with a high quality of evidence despite similar absolute numbers (1.4% vs. 2.8%). To keep in mind for shared decision‐making, sacubitril/valsartan reduces all‐cause mortality in HFrEF patients but for HFpEF further data are needed. Take into consideration the small number of studies to date to assess the risks. |
format | Online Article Text |
id | pubmed-8495680 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-84956802021-10-08 Benefits and adverse effects of sacubitril/valsartan in patients with chronic heart failure: A systematic review and meta‐analysis Charuel, Elodie Menini, Thibault Bedhomme, Sabrina Pereira, Bruno Piñol‐Domenech, Nathalie Bouchant, Suzy Boussageon, Rémy Bœuf‐Gibot, Sylvaine Vaillant‐Roussel, Helene Pharmacol Res Perspect Original Articles This review aims to assess the benefits and adverse effects of sacubitril/valsartan in heart failure, with a focus on important patient outcomes. A systematic review was conducted of double‐blind randomized controlled trials (RCTs) comparing sacubitril/valsartan versus a reference drug, in heart failure patients with reduced (HFrEF) and preserved (HFpEF) ejection fraction, published in French or English. Searches were undertaken of Medline, Cochrane Central, and Embase. The primary outcomes were all‐cause mortality and adverse events. From 2 082 articles analyzed, 5 were included. For all‐cause mortality, the absolute numbers for HFrEF (2 RCTs, 4627 patients) were 16% on sacubitril/valsartan and 18% on enalapril, with a risk ratio (RR) of 0.85 [CI = 0.78, 0.93], and 13% vs 14% in with HFpEF (2 RCTs, 5097 patients), with no statistical difference. Under the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, the evidence for HFrEF patients was of moderate quality. For HFrEF patients, an increased risk of symptomatic hypotension and angioedema (low quality of evidence) was shown. There was no statistical difference for the risk of hyperkalemia or worsening renal function. There was a protective RR (0.50 [0.34, 0.75]) for worsening renal function for patients with HFpEF, with a high quality of evidence despite similar absolute numbers (1.4% vs. 2.8%). To keep in mind for shared decision‐making, sacubitril/valsartan reduces all‐cause mortality in HFrEF patients but for HFpEF further data are needed. Take into consideration the small number of studies to date to assess the risks. John Wiley and Sons Inc. 2021-10-07 /pmc/articles/PMC8495680/ /pubmed/34617669 http://dx.doi.org/10.1002/prp2.844 Text en © 2021 The Authors. Pharmacology Research & Perspectives published by British Pharmacological Society and American Society for Pharmacology and Experimental Therapeutics and John Wiley & Sons Ltd. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made. |
spellingShingle | Original Articles Charuel, Elodie Menini, Thibault Bedhomme, Sabrina Pereira, Bruno Piñol‐Domenech, Nathalie Bouchant, Suzy Boussageon, Rémy Bœuf‐Gibot, Sylvaine Vaillant‐Roussel, Helene Benefits and adverse effects of sacubitril/valsartan in patients with chronic heart failure: A systematic review and meta‐analysis |
title | Benefits and adverse effects of sacubitril/valsartan in patients with chronic heart failure: A systematic review and meta‐analysis |
title_full | Benefits and adverse effects of sacubitril/valsartan in patients with chronic heart failure: A systematic review and meta‐analysis |
title_fullStr | Benefits and adverse effects of sacubitril/valsartan in patients with chronic heart failure: A systematic review and meta‐analysis |
title_full_unstemmed | Benefits and adverse effects of sacubitril/valsartan in patients with chronic heart failure: A systematic review and meta‐analysis |
title_short | Benefits and adverse effects of sacubitril/valsartan in patients with chronic heart failure: A systematic review and meta‐analysis |
title_sort | benefits and adverse effects of sacubitril/valsartan in patients with chronic heart failure: a systematic review and meta‐analysis |
topic | Original Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8495680/ https://www.ncbi.nlm.nih.gov/pubmed/34617669 http://dx.doi.org/10.1002/prp2.844 |
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