Does sacubitril-valsartan plus spironolactone induce ADRs?

Treatment with the combination of sacubitril-valsartan plus spironolactone during hospitalization for acute decompensated heart failure (ADHF) does not lead to a substantially higher incidence of adverse drug reactions (ADRs), a study has shown.

However, patients on this regimen tend to develop hyperkalaemia and have a greater incidence of readmission within 30 days due to ADRs.

This multicentre, retrospective, propensity-score matched cohort study was conducted at seven acute-care hospitals within a large healthcare system. 

Adult patients admitted with ADHF between 1 January 2019 and 31 December 2021 who received sacubitril-valsartan with mineralocorticoid receptor antagonist (MRA group) or without MRA (non-MRA group) and had a left ventricular ejection fraction (LVEF) <40 percent were included.

Of the 220 patients who underwent screening, 179 met the eligibility criteria. After propensity-score matching, 50 patients in the MRA group were matched to 50 individuals in the non-MRA group.

Overall, the incidence of ADR was similar between the two groups, with 20 percent in the MRA group and 24 percent in the non-MRA group (p=0.629). However, patients in the MRA group had a significantly higher incidence of hyperkalaemia (10 percent vs 0 percent; p=0.022).

In addition, none of the patients in the non-MRA group had a 30-day readmission due to an ADR as compared with 6 percent in the MRA group (p=0.079).

“Initiation of sacubitril-valsartan and MRA during hospitalization for ADHF may be an ideal time to optimize guideline-directed medical therapy,” the investigators said.