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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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