Most Read Articles
Jairia Dela Cruz, 14 Jan 2019
The potassium-competitive acid blocker vonoprazan demonstrates superior efficacy in the treatment of patients with erosive oesophagitis compared with the proton pump inhibitor lansoprazole, with the results of a small trial showing that the former more rapidly provides complete sustained heartburn relief during the first week of therapy.
01 Mar 2016
Bathing with 2% chlorhexidine gluconate-medicated washcloth is cost-effective for the prevention of central line-associated bloodstream infection (CLABSI), based on a systematic review and meta-analysis of four studies.
08 Jan 2019
Treatment with spironolactone has shown consistent, albeit modest, clinical effectiveness in older patients with heart failure with reduced ejection fraction (HFrEF) regardless of renal eligibility criteria used, a recent study has shown.
Rachel Soon, 12 Dec 2018

MIMS Pharmacist presents an overview of superoxide dismutase (SOD) and its role in resisting the effects of oxidative stress and aging.

Most patients on ARNI do not receive full dose

10 Jan 2018

Most patients on the angiotensin receptor-neprilysin inhibitor (ARNI) sacubitril/valsartan are started on the lowest dose and remain on the lowest or intermediate dose of the drug, data from primary care and cardiology practices in Germany have shown. [Wachter R, et al, AHA 2017, poster S5001]

Researchers retrospectively reviewed data from 1,095 primary care practices and 43 cardiology practices in Germany. The data set comprised a total of 1,643 patients prescribed sacubitril/valsartan, of whom 1,041 patients were from primary care practices and 692 were from cardiology practices.

Two-thirds of the patients (64 percent of the primary care cohort, 66 percent of the cardiology cohort) were started on the lowest dose of sacubitril/valsartan (26/24 mg BID). Among these patients, only 36 percent of those from the primary care cohort and 41 percent of those from the cardiology cohort had their sacubitril/valsartan dose up-titrated during a maximum follow-up period of 12 months. However, less than 11 percent of the patients received the target dose (103/97 mg BID) at the last recorded prescription.

Less than one-third of the patients (30 percent of the primary care cohort, 26 percent of the cardiology cohort) were initiated on the recommended starting dose of sacubitril/valsartan (51/49 mg BID). Among these patients, 24 percent of those from the primary care cohort and 36 percent of those from the cardiology cohort had their dose up-titrated to the target dose.

Only a small proportion (10 percent) of patients in each prescription group had their sacubitril/valsartan dose down-titrated.

Following the initiation of sacubitril/valsartan, the patients’ N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels decreased by approximately 30 percent (-503 pg/mL) – similar to the reduction observed in the PARADIGM-HF study.

Significant decreases in HbA1c (-0.3 percent; p<0.001) and systolic and diastolic blood pressure (-3.4 mm Hg and -1.6 mm Hg, respectively; p<0.001) were also observed following sacubitril/valsartan initiation. New York Heart Association class remained stable over time in the majority of patients.

“The effect of treatment with sacubitril/valsartan may have been greater if all patients had received the target dose,” the researchers suggested.

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Most Read Articles
Jairia Dela Cruz, 14 Jan 2019
The potassium-competitive acid blocker vonoprazan demonstrates superior efficacy in the treatment of patients with erosive oesophagitis compared with the proton pump inhibitor lansoprazole, with the results of a small trial showing that the former more rapidly provides complete sustained heartburn relief during the first week of therapy.
01 Mar 2016
Bathing with 2% chlorhexidine gluconate-medicated washcloth is cost-effective for the prevention of central line-associated bloodstream infection (CLABSI), based on a systematic review and meta-analysis of four studies.
08 Jan 2019
Treatment with spironolactone has shown consistent, albeit modest, clinical effectiveness in older patients with heart failure with reduced ejection fraction (HFrEF) regardless of renal eligibility criteria used, a recent study has shown.
Rachel Soon, 12 Dec 2018

MIMS Pharmacist presents an overview of superoxide dismutase (SOD) and its role in resisting the effects of oxidative stress and aging.