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Potential Expanded Indications for Neprilysin Inhibitors

  • Pharmacologic Therapy (W H W Tang, Section Editor)
  • Published:
Current Heart Failure Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

The goal of this article is to review potential expanded indications for neprilysin inhibitors. This article reviews the rationale and design for ongoing and future trials of sacubitril/valsartan in cardiovascular and non-cardiovascular disease.

Recent Findings

Randomized trial data are lacking for use of sacubitril/valsartan in acute heart failure and advanced heart failure. Mechanistic data from animal studies suggest a role for neprilysin inhibition in the treatment of post-myocardial infarction systolic dysfunction and heart failure with preserved ejection fraction. Beyond the cardiovascular system, renal and neurological function may be impacted by neprilysin inhibition. Forthcoming randomized trials will address the clinical impact of sacubitril/valsartan on these conditions.

Summary

Neprilysin inhibition with sacubitril/valsartan offers a new therapeutic strategy with a broad range of potential therapeutic actions. In PARADIGM-HF, the combination of neprilysin and RAAS inhibition was proven to be superior to enalapril for patients with stable NYHA class II–III heart failure and reduced left ventricular ejection fraction. Preliminary data suggests it may also have a role in other cardiovascular and non-cardiovascular disease. Several ongoing and planned studies will determine the extent of its benefit for these other indications.

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Acknowledgements

Dr Vader receives support from the NIH Grant U10 HL110309.

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  1. Cardiovascular Division, Washington University School of Medicine, 660 S. Euclid Ave., Box 8086, St Louis, MO, 63110, USA

    Elizabeth Riddell & Justin M. Vader

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Riddell, E., Vader, J.M. Potential Expanded Indications for Neprilysin Inhibitors. Curr Heart Fail Rep 14, 134–145 (2017). https://doi.org/10.1007/s11897-017-0327-y

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