PMID- 36648084
OWN - NLM
STAT- MEDLINE
DCOM- 20230320
LR  - 20230320
IS  - 1932-8737 (Electronic)
IS  - 0160-9289 (Print)
IS  - 0160-9289 (Linking)
VI  - 46
IP  - 3
DP  - 2023 Mar
TI  - Efficacy and safety of low-dose sacubitril/valsartan in heart failure patients: A 
      systematic review and meta-analysis.
PG  - 296-303
LID - 10.1002/clc.23971 [doi]
AB  - BACKGROUND: Controversy has persisted over the clinical benefits of low-dose 
      sacubitril/valsartan in patients with heart failure (HF). HYPOTHESIS: Low-dose 
      sacubitril/valsartan might also be effective and safe in HF patients. METHODS: 
      Electronic databases including PubMed, Ovid, and Cochrane Library were 
      systematically retrieved from inception to August 5, 2021. Review manager 5.4 and 
      Stata 15.1 were employed in this systematic review and meta-analysis. Key 
      efficacy outcomes of interest included HF hospitalization, all-cause mortality, 
      left ventricular ejection fraction (LVEF), N-terminal pro-B-type natriuretic 
      peptide (NT-proBNP), together with New York Heart Association (NYHA) functional 
      class. The safety outcome was systolic blood pressure (SBP). The grading of 
      recommendations assessment, development, and evaluation approach was conducted to 
      evaluate the quality of evidence for each outcome. RESULTS: A total of 1269 
      studies were screened and 9 real-world studies met the inclusion criteria were 
      included in the meta-analysis, with 1697 participants. Compared with low-dose 
      sacubitril/valsartan, high-dose sacubitril/valsartan significantly reduced the 
      risk of HF hospitalization (odds ratio [OR]: 0.4, 95% confidence interval [CI]: 
      0.27-0.61, p < .0001) and the risk of all-cause mortality (OR: 0.23, 95% CI: 
      0.11-0.47, p < .0001). However, there were no appreciable differences in 
      improvements of NYHA (OR: 0.59, 95% CI: 0.15-2.35, p = .45), changes of LVEF 
      (mean difference [MD]: 2.73%, 95% CI: -2.24% to 7.7%, p = .28), changes of 
      NT-proBNP (MD: 43.09, 95% CI: -28.41 to 114.59, p = .24) and changes of SBP (MD: 
      3.01, 95% CI: -4.62 to 10.64, p = .44) between groups with low-dose and high-dose 
      sacubitril/valsartan. CONCLUSIONS: Compared with high-dose sacubitril/valsartan, 
      low-dose sacubitril/valsartan was associated with increased risks of HF 
      hospitalization and all-cause mortality. However, no distinct between-group 
      differences in improvements of NYHA, changes of LVEF, changes of NT-proBNP and 
      changes of SBP were observed.
CI  - (c) 2023 The Authors. Clinical Cardiology published by Wiley Periodicals, LLC.
FAU - Chen, Wen-Wen
AU  - Chen WW
AUID- ORCID: 0000-0003-0975-0839
AD  - Department of Pharmacy, The Second Affiliated Hospital of Shandong First Medical 
      University, Tai'an, China.
FAU - Jiang, Juan
AU  - Jiang J
AD  - Department of Stomatology, The Second Affiliated Hospital of Shandong First 
      Medical University, Tai'an, China.
FAU - Gao, Jie
AU  - Gao J
AD  - Department of Pharmacy, The Second Affiliated Hospital of Shandong First Medical 
      University, Tai'an, China.
FAU - Zhang, Xiu-Zhen
AU  - Zhang XZ
AD  - Department of Pharmacy, The Second Affiliated Hospital of Shandong First Medical 
      University, Tai'an, China.
FAU - Li, Yuan-Min
AU  - Li YM
AUID- ORCID: 0000-0002-3385-3734
AD  - Department of Cardiology, The Second Affiliated Hospital of Shandong First 
      Medical University, Tai'an, China.
FAU - Liu, Yan-Lin
AU  - Liu YL
AD  - Department of Pharmacy, The Second Affiliated Hospital of Shandong First Medical 
      University, Tai'an, China.
FAU - Dang, He-Qin
AU  - Dang HQ
AD  - Department of Pharmacy, The Second Affiliated Hospital of Shandong First Medical 
      University, Tai'an, China.
LA  - eng
GR  - 2019QL017/Academic promotion programme of Shandong First Medical University/
GR  - 2020NS226/Tai'an City Science and technology Innovation development Project/
PT  - Journal Article
PT  - Meta-Analysis
PT  - Systematic Review
DEP - 20230117
PL  - United States
TA  - Clin Cardiol
JT  - Clinical cardiology
JID - 7903272
RN  - 17ERJ0MKGI (sacubitril)
RN  - 0 (Tetrazoles)
RN  - 0 (Angiotensin Receptor Antagonists)
RN  - 80M03YXJ7I (Valsartan)
RN  - 0 (Drug Combinations)
SB  - IM
MH  - Humans
MH  - Stroke Volume/physiology
MH  - *Ventricular Function, Left/physiology
MH  - Tetrazoles/adverse effects
MH  - Angiotensin Receptor Antagonists/adverse effects
MH  - Valsartan
MH  - *Heart Failure/diagnosis/drug therapy
MH  - Drug Combinations
PMC - PMC10018087
OTO - NOTNLM
OT  - dose
OT  - efficacy
OT  - heart failure
OT  - meta-analysis
OT  - sacubitril/valsartan
OT  - safety
COIS- The authors declare no conflict of interest.
EDAT- 2023/01/18 06:00
MHDA- 2023/03/21 06:00
PMCR- 2023/01/17
CRDT- 2023/01/17 07:13
PHST- 2022/12/09 00:00 [revised]
PHST- 2022/08/02 00:00 [received]
PHST- 2023/01/04 00:00 [accepted]
PHST- 2023/01/18 06:00 [pubmed]
PHST- 2023/03/21 06:00 [medline]
PHST- 2023/01/17 07:13 [entrez]
PHST- 2023/01/17 00:00 [pmc-release]
AID - CLC23971 [pii]
AID - 10.1002/clc.23971 [doi]
PST - ppublish
SO  - Clin Cardiol. 2023 Mar;46(3):296-303. doi: 10.1002/clc.23971. Epub 2023 Jan 17.