PIONEER-HF Analysis: Sacubitril/Valsartan Improves Outcomes in HFrEF

Transitioning from enalapril to sacubitril and valsartan was linked with a decrease in NT-proBNP in patients with acute decompensated heart failure (HF), results of an analysis of the PIONEER-HF study presented at the American College of Cardiology Annual Scientific Session in New Orleans suggested.

Researchers for the study looked at patients from the previously-published PIONEER-HF study, who had heart failure with reduced ejection fraction (HFrEF) and were hospitalized with acute decompensated HF. The original PIONEER-HF study results suggested the the in-hospital use of a sacubitril/valsartan combination led to a greater decrease in NT-proBNP than did treatment with enalapril, and also let to an improvement in clinical outcomes. There was also a four-week open-label study after week eight, with all patients receiving the combination therapy.

“In PIONEER-HF, patients stabilized after acute decompensated HF randomized to the in-hospital initiation of sacubitril/valsartan versus enalapril had a greater reduction in NT-proBNP over eight weeks,” the researchers wrote in their abstract. “There are limited data evaluating the impact of post-discharge initiation of sacubitril/valsartan.”

The present extended analysis of that patient population looked at the changes in NT-proBNP in those patients switching from enalapril to the combination therapy, and also to compare the totality of clinical events during the study period. The study included patients with HFrEF assigned to either the combination therapy of sacubitril/valsartan (n=440) or enalapril (n=441). A total of 415 patients switched from enalapril to the combination therapy, and 417 switched from the continued with the combination therapy.

According to the results, NT-proBNP levels decreased by an additional 18.5% in the combination therapy group, and by an additional 35.8% (P<0.001). Rates of death, HF hospitalization, or left ventricular assist device implantation remained lower in the combination therapy group compared to the enalapril group (HR-0.67; 95% CI, 0.48-0.94; P=0.020). Safety was comparable between study groups.

“Switching patients from enalapril to sacubitril/valsartan at eight weeks after randomization led to a further 36% reduction in NT-proBNP in patients with HFrEF and recent hospitalization for acute decompensated HF,” the researchers concluded in their presentation. “A strategy of in-hospital initiation of sacubitril/valsartan improved clinical outcomes over 12 weeks compared with a strategy of in-hospital initiation of enalapril followed by delayed sacubitril/valsartan.”

The researchers said that the results bolster the case for sacubitril/valsartan.

“While sacubitril/valsartan decreases NT-proBNP compared with enalapril regardless of when it is initiated, the early improvement in post-discharge outcomes supports the in-hospital initiation of sacubitril/valsartan in stabilized patients with acute decompensated HF,” the researchers said in their presentation.