30 Aug New Angiotensin–Neprilysin Inhibitor Bests Enalapril for Heart Failure
Medical Research: What are the main findings of the study?
Dr. McMurray: That compared to an evidence-based dose of an evidence-based ACE inhibitor (enalapril 10 mg bid), LCZ696 reduced the primary composite outcome of cardiovascular death or heart failure hospitalization by 20%, both the components of that composite and all-cause mortality (the latter by 16%) – all reductions are highly statistically significant and clinically important. LCZ696 treated patients also reported fewer symptoms and physical limitations due to heart failure. We think this is a remarkable finding – to beat what has been the gold-standard, cornerstone, therapy for around 25 years. The findings show conclusively that adding neprilysin inhibition to renin-angiotensin system blockade is superior to renin-angiotensin system blockade alone in patients with heart failure and reduced ejection fraction .
Medical Research: Were any of the findings unexpected?
Dr. McMurray: The rapidity of onset of benefit – was apparent very quickly – and the magnitude of the benefit, given that we were comparing the new treatment to an existing active, effective, therapy and also giving the new treatment on top of other effective therapies.
Medical Research: What should clinicians and patients take away from your report?
Dr. McMurray: They will probably want to switch to this new type of treatment if and when it is approved.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. McMurray: We have just started a new trial in patients with heart failure and preserved ejection fraction.
Angiotensin–Neprilysin Inhibition versus Enalapril in Heart Failure
John J.V. McMurray, M.D., Milton Packer, M.D., Akshay S. Desai, M.D., M.P.H.,Jianjian Gong, Ph.D., Martin P. Lefkowitz, M.D., Adel R. Rizkala, Pharm.D.,
Jean L. Rouleau, M.D., Victor C. Shi, M.D., Scott D. Solomon, M.D.,
Karl Swedberg, M.D., Ph.D., and Michael R. Zile, M.D.,
for the PARADIGM-HF Investigators and Committees
August 30, 2014DOI: 10.1056/NEJMoa1409077