Sheppard Christina E, Anwar Maria
Cardio-Oncology Clinic, Alberta Health Services, Calgary, Canada.
J Oncol Pharm Pract. 2019 Jul;25(5):1231-1234. doi: 10.1177/1078155218783238. Epub 2018 Jun 27.
Sacubitril/valsartan has been shown to significantly reduce cardiovascular mortality and hospitalizations due to heart failure in adult patients with reduced ejection fraction when compared to enalapril. To the best of our knowledge, the combination of sacubitril (neprilysin inhibitor) and valsartan (angiotensin receptor blocker) has not been evaluated in patients with chemotherapy-induced cardiomyopathy, as these patients were excluded from the recent pivotal trial, PARADIGM-HF. However, current guidelines for the evaluation and management of cardiovascular complications of cancer therapy, published by the Canadian Cardiovascular Society, direct clinicians to the Canadian Cardiovascular Society Heart Failure Guidelines for the management of cancer patients who develop clinical heart failure or an asymptomatic decline in left ventricular ejection fraction (e.g. >10% reduction from baseline or left ventricular ejection fraction <53%), which could include the use of sacubitril/valsartan.
Retrospective descriptive comparative case study of two patients treated with sacubitril/valsartan.
We present data from two patients who experienced anthracycline-induced cardiomyopathy and were successfully managed with sacubitril/valsartan after suboptimal responses to traditional evidence-based heart failure therapies. Both patients demonstrated some recovery of function and normalization of N-terminal pro B-type natriuretic peptide levels. Sacubitril/valsartan was well tolerated with minimal side effects. To date, neither patient has required hospitalization or additional clinic interventions for heart failure.
While further large scale studies are required to determine a comprehensive safety and efficacy profile, we report two cases of anthracycline-induced cardiomyopathy survivors managed with sacubitril/valsartan with minimal side effects and no hospitalizations.
与依那普利相比，沙库巴曲缬沙坦已被证明可显著降低射血分数降低的成年心力衰竭患者的心血管死亡率和因心力衰竭导致的住院率。据我们所知，沙库巴曲（中性肽链内切酶抑制剂）和缬沙坦（血管紧张素受体阻滞剂）的联合用药尚未在化疗所致心肌病患者中进行评估，因为这些患者被排除在近期的关键试验PARADIGM-HF之外。然而，加拿大心血管学会发布的癌症治疗心血管并发症评估和管理的现行指南，将临床医生引向加拿大心血管学会心力衰竭指南，以管理出现临床心力衰竭或左心室射血分数无症状下降（例如，较基线降低>10%或左心室射血分数<53%）的癌症患者，这可能包括使用沙库巴曲缬沙坦。
对两名接受沙库巴曲缬沙坦治疗的患者进行回顾性描述性比较病例研究。
我们展示了两名经历蒽环类药物所致心肌病的患者的数据，他们在对传统循证心力衰竭治疗反应欠佳后，成功接受了沙库巴曲缬沙坦治疗。两名患者均表现出一定程度的功能恢复和N末端B型利钠肽前体水平正常化。沙库巴曲缬沙坦耐受性良好，副作用极小。迄今为止，两名患者均未因心力衰竭需要住院或额外的门诊干预。
虽然需要进一步的大规模研究来确定全面的安全性和有效性概况，但我们报告了两例蒽环类药物所致心肌病幸存者接受沙库巴曲缬沙坦治疗，副作用极小且未住院。
