According to the results of PARADIGM-HF trial (presented in ESC congress and published in the NEJM in September 2014) the LCZ696 (ARNI-Angiotensin Receptor–Neprilysin Inhibitor) seems to be the new effective drug for patients with heart failure (HF) and a reduced ejection fraction. The result of the study was impressive, as LCZ696 reduced the risk of cardiovascular death or HF hospitalisation by 20% compared with enalapril. I was cautiously optimistic about these findings, but I must admit that I did not expect that these results would change the guidelines for the management of HF only 2 months after presented study. According to the Medscape news Canadian Cardiovascular Society guidelines for the management of patients with HF have been updated and are the first to include a recommendation on the use of the new angiotensin receptor-neprilysin inhibitor. Is only one trial enough to change guidelines recommendations? Is this only based on our extremely enthusiasm of the study or the study simply answered all our questions?
http://www.nejm.org/doi/full/10.1056/NEJMoa1409077?query=featured_home&#t=article
http://www.medscape.com/viewarticle/834253?src=wnl_edit_tpal&uac=96434FN
Martha:
I agree with you and it is a good question. I remember another recent trial on this field coming with stars promises but soon receive heavy criticism I refer RELAX-AF (DOI: 10.1161/CIRCOUTCOMES.113.000418 - march -2014). Indeed we all want anything better than we have acctually in treatment of heart failure and seems LCZ696 may be a real hope, caution is not bad. God bless you
This neprilysin inhibitor study indeed is fascinating!
Provided that the coming months do not reveal significant limitations to this NEJM study, I would expect that the next ESC task force would assign a I B recommendation for the use of LCZ696. The strongest level of recommemdation I A will only be given for a therapy based on more than one RCT.
Look at the definition of classes and levels of recommemdation in each guideline and you will find the precise answer to your interesting question.
Thierry Gillebert
Mobile
the design of the PARADIGM-HF trial is very controversial, for a discussion see here
http://www.cardioexchange.org/voices/lets-scrutinize-paradigm-hf/
so it is way too early to change guidelines recommendations.
http://www.cardioexchange.org/voices/lets-scrutinize-paradigm-hf/
Indeed very good results in HF field that was somehow lacking new effective medications in the last years (ivabradine somehow failed to impress me with beta blockers around). Of course, having red the critiques of PARADIGM-HF i would agree that it is sill a bit early for LCZ696 to change the guidelines (it needs at lest one more big RCT), but I still feel the results of the study are impressive and the drug could play a role in future treatment of HF.
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