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Independents' Day

NICE recommends 'game-changing' heart failure drug

NICE has given the green light in new guidance to a heart failure drug hailed as a ‘game changer’ by experts, but only as a second-line treatment.

The drug, a sacubitril valsartan combination, can be offered to patients with reduced left ventricular ejection fraction (≤35%), but only if they are currently taking a stable dose of ACE inhibitors or ARBs and their symptoms have failed to respond to treatment. NICE recommends that treatment should be initiated by a heart failure specialist.

NICE said the treatment will be available to more than 100,000 patients and could reduce some of the 30,000 related hospital admissions each year. But it added that it will not be available to all heart failure patients as it is not ’cost effective’ to give to patients with less severe symptoms. 

It comes as Scottish regulator SIGN last month recommended that GPs could offer sacubitril valsartan – branded Entresto – as second-line treatment to patients with decreased systolic function, after evidence showed that it reduced hospital admissions.

Readers' comments (5)

  • Vinci Ho

    PARADIGM-HF trial: Sacubitril (blocks the enzyme ,neprilysn , which in turn,breaks down BNP and ANP). Together with valsartan(LCZ696)versus enalapril:

    The trial was stopped early, according to prespecified rules, after a median follow-up of 27 months, because the boundary for an overwhelming benefit with LCZ696 had been crossed. At the time of study closure, the primary outcome had occurred in 914 patients (21.8%) in the LCZ696 group and 1117 patients (26.5%) in the enalapril group (hazard ratio in the LCZ696 group, 0.80; 95% confidence interval [CI], 0.73 to 0.87; P

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  • Vinci Ho

    A total of 711 patients (17.0%) receiving LCZ696 and 835 patients (19.8%) receiving enalapril died (hazard ratio for death from any cause, 0.84; 95% CI, 0.76 to 0.93; P<0.001); of these patients, 558 (13.3%) and 693 (16.5%), respectively, died from cardiovascular causes (hazard ratio, 0.80; 95% CI, 0.71 to 0.89; P<0.001). As compared with enalapril, LCZ696 also reduced the risk of hospitalization for heart failure by 21% (P<0.001) and decreased the symptoms and physical limitations of heart failure (P=0.001). The LCZ696 group had higher proportions of patients with hypotension and nonserious angioedema but lower proportions with renal impairment, hyperkalemia, and cough than the enalapril group.

    Not quite comfortable with the label 'game changer',

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  • Our prescribing budget is bust.
    My CCF patient is 3 weeks as in patient.soon hospital budget will blow.
    We don't get £300 per patient ..any ideas on next year budget management

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  • Dear All,
    Yes a bit like the nonsense that Naproxen is safer than Diclofenac.
    Good analysis.
    Paul C

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  • It's good to have a new treatment.
    Interesting to note the use of enalapril as the comparator drug. It is the evidence based drug in heart failure...
    Reduces mortality by 25% and 40% in severe failure like this, so to do better is impressive.

    Probably worth mentioning though that spironolactone in Rales study as an add on gave a 30% extra reduction in mortality ... But watch the electrolytes!

    And don't forget the bblocker ... 25% reduction in mortality.

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