2 responses to “Angiotensin Receptor Neprilysin Inhibitor (ARNI) in Heart Failure with Reduced Ejection Fraction (HFrEF): Sacubiltril/Valsartan and the PARADIGM HF Trial”

  1. As the authors point accurately point out, a limitation in the use of this drug will be hypotension. In the key trial, hypotension was an exclusion criteria. The trial also had a run in period so that those with adverse effects or no benefit were excluded. The real life use of this drug can be reasonably expected to have poorer results than the trial subjects so the 1 % improvement in mortality may not even be found.

  2. Good comments by Dr Etches above. My thoughts are as follows :

    1) The cost will be prohibitive for many patients unless covered by a third party. i doubt it will be initiated in primary care.

    2) Why is it marketed as a combination pill with valsartan and not as a stand alone medication? Most medications start as stand alone and then become combination pills to help with compliance or cost after introduction.

    3) Finally, The trail seems to have been sufficiently large and long to be meaningful but i dont understand why they ran ENALAPRIL 10mg BID v Sacubiltril/Valsartan BID? Why not Valsartan v Sacubiltril/Valsartan, which would have removed any difference attributable to the difference between the ACE and ARB

    I tried looking for a trail to compare Enalapril V Valsartan in heart failure but only found a small brief trail. Though in one larger trial Valsartan seemed equivilent to captopril.

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