Benefits and adverse effects of sacubitril/valsartan in patients with chronic heart failure: A systematic review and meta‐analysis

Abstract 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...

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Autores principales:	Elodie Charuel, Thibault Menini, Sabrina Bedhomme, Bruno Pereira, Nathalie Piñol‐Domenech, Suzy Bouchant, Rémy Boussageon, Sylvaine Bœuf‐Gibot, Helene Vaillant‐Roussel
Formato:	article
Lenguaje:	EN
Publicado:	Wiley 2021
Materias:	decision making shared general practice heart failure sacubitril‐valsartan systematic review Therapeutics. Pharmacology RM1-950
Acceso en línea:	https://doaj.org/article/fa5b5a2ee1cc43b18969c5f63d2579ca
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spelling	oai:doaj.org-article:fa5b5a2ee1cc43b18969c5f63d2579ca2021-11-16T13:45:54ZBenefits and adverse effects of sacubitril/valsartan in patients with chronic heart failure: A systematic review and meta‐analysis2052-170710.1002/prp2.844https://doaj.org/article/fa5b5a2ee1cc43b18969c5f63d2579ca2021-10-01T00:00:00Zhttps://doi.org/10.1002/prp2.844https://doaj.org/toc/2052-1707Abstract 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.Elodie CharuelThibault MeniniSabrina BedhommeBruno PereiraNathalie Piñol‐DomenechSuzy BouchantRémy BoussageonSylvaine Bœuf‐GibotHelene Vaillant‐RousselWileyarticledecision making sharedgeneral practiceheart failuresacubitril‐valsartansystematic reviewTherapeutics. PharmacologyRM1-950ENPharmacology Research & Perspectives, Vol 9, Iss 5, Pp n/a-n/a (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	decision making shared general practice heart failure sacubitril‐valsartan systematic review Therapeutics. Pharmacology RM1-950
spellingShingle	decision making shared general practice heart failure sacubitril‐valsartan systematic review Therapeutics. Pharmacology RM1-950 Elodie Charuel Thibault Menini Sabrina Bedhomme Bruno Pereira Nathalie Piñol‐Domenech Suzy Bouchant Rémy Boussageon Sylvaine Bœuf‐Gibot Helene Vaillant‐Roussel Benefits and adverse effects of sacubitril/valsartan in patients with chronic heart failure: A systematic review and meta‐analysis
description	Abstract 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	article
author	Elodie Charuel Thibault Menini Sabrina Bedhomme Bruno Pereira Nathalie Piñol‐Domenech Suzy Bouchant Rémy Boussageon Sylvaine Bœuf‐Gibot Helene Vaillant‐Roussel
author_facet	Elodie Charuel Thibault Menini Sabrina Bedhomme Bruno Pereira Nathalie Piñol‐Domenech Suzy Bouchant Rémy Boussageon Sylvaine Bœuf‐Gibot Helene Vaillant‐Roussel
author_sort	Elodie Charuel
title	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_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_sort	benefits and adverse effects of sacubitril/valsartan in patients with chronic heart failure: a systematic review and meta‐analysis
publisher	Wiley
publishDate	2021
url	https://doaj.org/article/fa5b5a2ee1cc43b18969c5f63d2579ca
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Benefits and adverse effects of sacubitril/valsartan in patients with chronic heart failure: A systematic review and meta‐analysis

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