The FDA has approved Entresto (Novartis), an oral fixed-dose combination of the neprilysin inhibitor sacubitril and the angiotensin receptor blocker (ARB) valsartan, to reduce the risk of cardiovascular death and heart failure hospitalization in patients with heart failure with reduced ejection fraction. Sacubitril is the first neprilysin inhibitor to become available in the US.
Patients with symptomatic heart failure with reduced ejection fraction generally take an angiotensin-converting enzyme (ACE) inhibitor, a beta blocker, and an aldosterone antagonist (Table). If volume overloaded, they may take a diuretic as well. An ARB is recommended for patients who cannot tolerate an ACE inhibitor.1
Sacubitril/Valsartan (Entresto) for Heart Failure. JAMA. 2015;314(7):722-723. doi:10.1001/jama.2015.9398