Kardiologie up2date 2015; 11(01): 2-8
DOI: 10.1055/s-0034-1391741
Hotline – Herzinsuffizienz
© Georg Thieme Verlag KG Stuttgart · New York

PARADIGM-HF-Studie

Müssen die Leitlinien zur medikamentösen Behandlung der chronischen Herzinsuffizienz jetzt umgeschrieben werden?
Markus Haass
Further Information

Publication History

Publication Date:
08 April 2015 (online)

Abstract

The PARADIGM-HF study is so far the largest study in heart failure, which included more than 8000 patients with symptomatic HFrEF. Due to superiority of the combined angiotensin receptor-neprilysin-inhibitor LCZ696 the PARADIGM-HF study was terminated early after a median follow-up of 27 months. Compared to „standard therapy“ with high-dose enalapril (10 mg bid) LCZ696 (200 mg bid, consisting of 160 mg valsartan plus 40 mg sacubitril) not only reduced the primary endpoint of death from cardiovascular causes and hospitalization for heart failure by 20 %, but also death from any cause by 16 %. The overall tolerability of LCZ696 was better than that of enalapril. Serious angioedema were not oberserved. LCZ696 increases plasma levels of BNP by inhibiting its degradation. Therefore, the plasma levels of NT-proBNP appear to be better suited for follow-up of heart failure patients treated with LCZ696. Due to the remarkable results of PARADIGM-HF study LCZ696 appears to soon replace ACE-inhibitors as standard therapy in symptomatic HFrEF and the guidelines for treatment of heart failure are required to be updated.

 
  • Literatur

  • 1 Haass M. Leitliniengerechte medikamentöse Therapie der Herzinsuffizienz. Aktuel Kardiol 2014; 3: 1-7
  • 2 Hasenfuß G, Anker S, Bauersachs J et al. Kommentar zu den Leitlinien der Europäischen Gesellschaft für Kardiologie (ESC) zur Diagnostik und Behandlung der akuten und chronischen Herzinsuffizienz. Kardiologie 2013; 7: 105-114
  • 3 McMurray JJ, Adamopoulos S, Anker SD et al. ESC Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J 2012; 33: 1787-1847
  • 4 Haass M, Simonis G. Serelaxin – neuer medikamentöser Ansatz bei akuter Herzinsuffizienz. Kardiologie up2date 2013; 9: 6-12
  • 5 Fournie-Zaluski MC, Coric P, Turcaud S et al. New dual inhibitors of neutral endopeptidase and angiotensin-converting enzyme: rational design, bioavailability, and pharmacological responses in experimental hypertension. J Med Chem 1994; 37: 1070-1083
  • 6 Packer M, Califf RM, Konstam MA et al. Comaprison of omapatrilat and enalapril in patients with chronic heart failure: the Omapatrilat Versus Enalapril Randomized Trial of Utility in Reducing Events (OVERTURE). Circulation 2002; 106: 920-926
  • 7 McMurray JJ, Packer M, Desai AS et al. Angiotensin-neprilysin inhibition versus enalapril in heart failure. N Engl J Med 2014; 371: 993-1004
  • 8 Packer M, McMurray JJ, Desai AS et al. Angiotensin receptor neprilysin inhibition compared with enalapril on the risk of clinical progression in surviving patients with heart failure. Circulation 2015; 131: 54-61
  • 9 McMurray J, Packer M, Desai A et al. A putative placebo analysis of the effects of LCZ696 on clinical outcomes in heart failure. Eur Heart J 2014; [Epub ahead of print]
  • 10 Solomon SD, Zile M, Pieske B et al. The angiotensin neprilysin inhibitor LCZ696 in heart failure with preserved ejection fraction: a phase 2 double-blind randomised controlled trial. Lancet 2012; 380: 1387-1395