Comparative efficacy of vericiguat to sacubitril/valsartan for patients with heart failure reduced ejection fraction: Systematic review and network meta-analysis.
Int J Cardiol
; 400: 131786, 2024 Apr 01.
Article
in En
| MEDLINE
| ID: mdl-38242507
ABSTRACT
BACKGROUND:
Despite the established efficacy of vericiguat compared to placebo, uncertainties remain regarding its comparative efficacy to sacubitril/valsartan for patients with heart failure reduced ejection fraction (HFrEF). This study aimed to assess the relative efficacy of vericiguat and sacubitril/valsartan through a systematic review, network meta-analysis, and non-inferiority tests.METHODS:
A systematic review was conducted to identify the randomized phase 3 clinical trials involving vericiguat and sacubitril/valsartan. The hazard ratios (HRs) with 95% confidence intervals (CI) for cardiovascular death (CVD) and hospitalization due to HF (hHF) were extracted from these trials and synthesized via network meta-analysis. Non-inferiority testing of vericiguat was performed using a fixed-margin method with a predefined non-inferiority margin (1.24). Sensitivity analyses explored the impact of the time from hHF to screening.RESULTS:
Among the 1366 studies, two trials (VICTORIA and PARADIGM-HF) met the inclusion criteria. Network meta-analysis demonstrated that the HR for CVD or hHF with vericiguat did not significantly differ from that for sacubitril/valsartan (HR 0.88, 95% CI0.62-1.23). The upper limit of the 95% CI was less than the predefined margin of 1.24, confirming vericiguat's non-inferiority to sacubitril/valsartan. Sensitivity analyses affirmed the robustness of the base-case results.CONCLUSION:
Vericiguat exhibited a comparable risk of CVD or hHF when contrasted with sacubitril/valsartan. Importantly, in patients with HFrEF, vericiguat's efficacy was not statistically inferior to that of sacubitril/valsartan. These findings reinforce the potential of vericiguat as a viable treatment option for this patient population.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Stroke Volume
/
Tetrazoles
/
Biphenyl Compounds
/
Drug Combinations
/
Angiotensin Receptor Antagonists
/
Valsartan
/
Network Meta-Analysis
/
Aminobutyrates
/
Heart Failure
Type of study:
Clinical_trials
/
Prognostic_studies
/
Systematic_reviews
Limits:
Humans
Language:
En
Journal:
Int J Cardiol
/
Int. j. cardiol
/
International journal of cardiology
Year:
2024
Document type:
Article
Affiliation country:
Estados Unidos
Country of publication:
Países Bajos