Naprilysin inhibitors – a breakthrough for heart failure patients
Heart failure is a wretched condition. The heart for many reasons doesn’t pump effectively and as a result a person with the condition will experience breathlessness and a tendency to retain fluid. This is often seen initially as swelling around the ankles and as the fluid accumulates in the lung the person will find it progressively more difficult to lie flat because of breathlessness.
Thankfully we have developed a huge portfolio of drug treatments to improve symptoms and have transformed the dismal prognosis relating to this condition. More recently patients with particular characteristics may benefit from the insertion of a complex pacemaker which helps co-ordinate the contraction of the heart muscle.
We have come to realize that the most important way of helping a patient with heart failure is getting them to take their tablets (compliance). This is one reason why nurses who are dedicated to treating patients with heart failure are so effective at their job.
For the last 10 years there have been no novel new drugs that have been developed for the treatment of heart failure. It is difficult to show that a new drug makes an impact over current treatment when a patient is already taking a combination of 5 or more. However last year a clinical trial with a new drug LCZ696, a drug containing a naprilysin inhibitor sacubitril, showed a 20% reduction in mortality over and above the normal treatment. It is undoubtedly novel, potent and well tolerated. We are now awaiting its introduction to Britain and will see NICE review its effectiveness early next year.
What will stop it being prescribed? Cost. In the USA it has just been licensed for use and the cost is $12.50 per day – roughly £8 per day or £3000 a year. Novartis the company manufacturing this drug will do well to make it significantly cheaper in Britain otherwise the cash strapped health service will be very slow to introduce it.
I suspect most patients with heart failure I treat medically if offered the choice of £3000 in cash or a years treatment with LCZ696 will take the money.