Neprilysin inhibitor–angiotensin II receptor blocker combination (sacubitril/valsartan): rationale for adoption in SARS-CoV-2 patients

COVID-19 y enfermedad cardiovascular y renal: ¿Dónde estamos? ¿Hacia dónde vamos?

“…Hasta la fecha no hay evidencia clínica que respalde los efectos adversos o beneficiosos de los BSRAA en pacientes con COVID-19, y en línea con las directrices de las principales sociedades de cardiología e hipertensión, los pacientes con IECA o ARAII no deben interrumpir su tratamiento 7,11,12 .…”

“…Recientemente, Acanfora et al 11 describen una hipótesis como posible enfoque alternativo para el tratamiento de la COVID-19 en base al tratamiento con sacubitrilo/valsartán utilizado en el manejo de la insuficiencia cardíaca (IC) 13 . Proponen, en base a los argumentos anteriores sobre el BSRAA, que se revise también el papel de la neprilisina y su inhibidor sacubitrilo asociado a valsartán, ya que se ha observado que la combinación de ambos reduce la concentración de citocinas proinflamatorias y el recuento de neutrófilos, al tiempo que aumenta el recuento de linfocitos.…”

Sacubitril/valsartan in COVID-19 patients: the need for trials

“…We thank Luigi Petramala and Claudio Letizia for their comment 1 on our letter about the possible role of sacubitril/valsartan in patients with coronavirus disease 2019 (COVID-19). 2 The authors rightly affirm the need for continuing previous therapies with angiotensinconverting enzyme inhibitors (ACE-Is) or sartans in patients with COVID-19, as outlined by recent international consensus papers. 3 There is no definite evidence about the harmful or protective use of ACE-Is/sartans in COVID-19 patients.…”

Renin-Angiotensin System Inhibitors in COVID-19: Current Concepts

“…The use of ARNI (angiotensin receptor neprilysin inhibitor) in COVID-19 patients is likely to exhibit the same responses (beneficial/harmful) as ACE/ARB. Interestingly, an author recently suggested an additional mechanism of benefit with ARNI in COVID-19 [ 26 ]. Based on its studies in acute heart failure patients, sacubitril/valsartan demonstrated a reduction in the concentration of proinflammatory cytokines and neutrophil count while increasing the lymphocyte count more than valsartan alone or placebo.…”

“…Based on its studies in acute heart failure patients, sacubitril/valsartan demonstrated a reduction in the concentration of proinflammatory cytokines and neutrophil count while increasing the lymphocyte count more than valsartan alone or placebo. Such an effect is likely to protect against the COVID-19-associated organ damage, which is usually mediated by cytokine storm and decreased lymphocyte count [ 26 ]. Secondly, ARNI has demonstrated a stabilizing effect among patients admitted with acute heart failure and decreased the composite end point of all-cause death and heart failure hospitalizations [ 27 ].…”