Anfang diesen Jahres nahm die European Society of Cardiology das Kombinationspräparat
Sacubitril/ Valsartan in ihre Leitlinien zur Behandlung der chronischen Herzinsuffizienz
auf. Auch das IQWIG bescheinigte einen „beträchtlichen Zusatznutzen“, den es allerdings
später aufgrund von Sensitivitätsanalysen für Diabetiker einschränkte. Welche Konsequenzen
ziehen sich nun aus dieser Neueinschätzung für die Behandlung herzinsuffizienter Diabetiker
im Praxisalltag?
Abstract
Sacubitril / Valsartan proofed to be an effective treatment compared to enalapril
in reducing heart failure hospitalisations and mortality in patients with severe „Heart
failure with reduced ejection fraction“ (HFREF). Recent European cardiology guidelines
attributed a class IB recommendation for Sacubitril / Valsartan in HFREF patients
who remain symptomatic despite optimal treatment with ACE-I, a beta-blocker, and a
mineralocorticoid receptor antagonist. There is a significant overlap between diabetic
and HFREF patients and thus, efficacy assessment of Sacubitril / Valsartan is a clinically
meaningful issue in the large subgroup of HFREF patients with diabetes. We discuss
the present evidence why local authorities speculated about a potential interaction
between the two diseases decreasing the efficacy of sacubitril/valsartan in terms
of reducing relevant end-points in this cohort. Overall, Sacubitril / Valsartan is
obviously a treatment option in diabetics with HFREF. However, diabetic cardiomyopathy
needs to be recognised as a specific disease condition.
Schlüsselwörter
Wirksamkeit - Effektmodulation - Subgruppenanalyse
Keywords
efficacy - effect modulation - subgroup analysis
