Real‐world treatment patterns of sacubitril/valsartan: a longitudinal cohort study in Germany

Abstract

Aims To analyse real‐world treatment patterns of sacubitril/valsartan (sac/val) using data from a pharmacy database in Germany. Methods and results A retrospective cohort study of 26 191 adult patients (aged ≥ 18 years) in the IMS® longitudinal prescriptions database in Germany who were dispensed sac/val from January 2016 to June 2017 was conducted. The analysis included sac/val dose titration assessed in the 6 months from first sac/val prescription; prescriptions of concomitant cardiovascular medications in the 6 months pre‐ and post‐index and compliance and persistence during 12 months post‐index. Two‐thirds of patients were prescribed the lowest sac/val dose of 50 mg twice daily (b.i.d.) at index and up‐titration during the first 6 months was attempted in 41% of these patients. Ten percent of patients prescribed 200 mg b.i.d. at index had to be stably down‐titrated; among patients prescribed 50 or 100 mg b.i.d. at index that were up‐titrated, > 80% remained on the higher dose. Overall, the mean daily diuretic dose decreased by 25% after initiation of sac/val. High compliance and persistence rates were observed across sac/val doses, increasing with higher sac/val dose at index. Prior dose of angiotensin‐converting enzyme inhibitor or angiotensin receptor blocker had only minor impact on first sac/val dose, compliance and persistence. Conclusions Most patients prescribed sac/val are not initiated on the recommended dose nor up‐titrated as recommended by the EU Summary of Product Characteristics. Initiation of sac/val was associated with high persistence and compliance and a dose reduction of diuretics. Barriers to up‐titration must be explored.

Sacubitril‐Valsartan in a routine community population: attention to volume status critical to achieving target dose

“…In the main, observations have been in line with what has been reported in the clinical trial data . However, there has been a lower rate of achievement of the target dose (TD), with the majority of studies reaching TD in less than 50% the patients, including a large cohort in Germany . To our knowledge, only one study to date had reported success in titration to TD in greater than 50% of the cases .…”

“…Some studies have reported rates as low as 17%, and the majority of studies achieved the maximum dose in less than 50% of individuals. 11,15,16 Given that emerging data indicate that the higher doses are associated with superior clinical response, 11,18 close analyses of the impediments to dose titration in the community are warranted in order to provide guidance on how best this agent in this setting. Our data demonstrate that the clinical trial dose of sacubitril-valsartan can be achieved in a significant proportion of the population.…”

“…[10][11][12][13] However, there has been a lower rate of achievement of the target dose (TD), with the majority of studies reaching TD in less than 50% the patients, 14,15 including a large cohort in Germany. 16 To our knowledge, only one study to date had reported success in titration to TD in greater than 50% of the cases. 17 Given that achieving maximum dose seems to have an impact on outcome, 11,18 a fuller understanding is needed of the success and difficulties of titration of this agent in community HF-rEF.…”

Initiation of sacubitril/valsartan in haemodynamically stabilised heart failure patients in hospital or early after discharge: primary results of the randomised TRANSITION study

“…The finding that 62% of the patients up-titrated to 49/51 or 97/103 mg bid of sacubitril/valsartan are relevant when compared to registry data, showing only 43% of patients receiving more than 24/26 mg bid of sacubitril/valsartan in an outpatient setting. 16,17 This gap between data from controlled trials and daily practice requires further study, and gives room for future improvement in HF therapy. 18 -20 The results of TRANSITION provide support to continuing the efforts of up-titration after discharge.…”

The Effect of Sacubitril/Valsartan on Clinical and Laboratory Findings Comparatively in Ischemic and Non-Ischemic Heart Failure Patients

“…9,23 Buna karşın yeni yayımlanan çalışmalarda da çalışmamızda olduğu gibi hastalarda sakubitril/valsartan tedavisi sonrasında diüretik ihtiyacında azalma olduğu görülmüştür. [23][24][25] Sakubitril, BNP'yi yıkan ve bir anjiyotensin reseptör nötral endopeptidaz olan neprilisini inhibe ederek kandaki natriüretik peptid seviyelerini artırmaktadır. 26 Yeni yayımlanan çalışmaların sonuçlarına göre sakubitril/valsartan tedavisi atriyal natriüretik seviyesini artırırken, NT-pro BNP seviyesini çalışmamızda olduğu gibi azaltmıştır.…”