LAUSR

Introduction Sacubitril/valsartan (S/V) has been shown to decrease N-terminal pro-B-type natriuretic peptide (NT-pro BNP) levels. Reduction of NT-proBNP is associated with lower morbidity and mortality rates. However, there is very little data with the effects of low dose S/V on NT-proBNP. Methodology This was a retrospective study conducted between October 2015 and January 2018 of patients who received either low dose or very low dose S/V. Patients were divided into 3 groups based on S/V dosing. Group 1 patients received very low dose, group 2 patients received very low dose titrated to low dose, and group 3 patients received low dose. The primary endpoint was the change in NT-proBNP levels between baseline and the most recent obtained value. Results A total of 293 patients were reviewed and 45 patients met inclusion criteria. Across all S/V dosing groups, there was a statistically significant reduction in NT-proBNP levels. The average days of therapy between NT-proBNP values were 108, 149, and 196 in group 1, 2, and 3, respectively. 71% of patients were on loop diuretics prior to S/V with an average furosemide equivalent dose of 73mg which decreased by 27% to 53mg after receiving S/V. Conclusion Low doses of S/V, including half of the lowest dose clinically available, appears to have substantial benefit in terms of NT-proBNP which can be seen within 3 to 6 months. Despite a reduction in loop diuretic dose, there was still a significant reduction in NT-proBNP which may be attributed to the natriuretic effect of S/V. Although reductions in NT-proBNP levels are associated with improvements in survival, these data cannot be used to infer that a similar reduction in mortality would be expected. However, they do suggest that very low doses of S/V appear to have a biochemical effect and perhaps should be studied in future trials since not all patients can be titrated to the maximum dose of S/V. While patients should be titrated to guideline recommended doses, low doses seem to be beneficial in terms of reducing NT-proBNP levels.