Sacubitril-valsartan new users had a lower risk of angioedema compared with ACE inhibitor new users (HR 0.18; 95% CI 0.11-0.29), but recent switchers from ACEi or ARB to SV faced increased risk.
Cohort
Does sacubitril-valsartan increase the risk of angioedema compared to ACE inhibitors or ARBs in new users or recent switchers?
Sacubitril-valsartan does not increase angioedema risk compared to ACE inhibitors or ARBs in naive users, but recent switching from ACEi or ARB to SV significantly increases this risk.
Effect estimate: HR 0.18 (95% CI 0.11-0.29)
BACKGROUND: Data on angioedema risk among sacubitril-valsartan (SV) users in real-world settings are limited. OBJECTIVES: We sought to evaluate the risk of angioedema among SV new users compared with angiotensin-converting enzyme (ACE) inhibitor and angiotensin-receptor-blocker (ARB) new users separately. METHODS: We conducted a propensity score-matched cohort study, comparing SV new users (no use of SV, ACE inhibitor, ARB 6 months before) and SV new users with prior use (within 183 or 14 days) of ACE inhibitor or ARB (ACE inhibitor-SV and ARB-SV users; recent ACE inhibitor-SV and recent ARB-SV users, respectively) vs ACE inhibitor and ARB new users separately. RESULTS: Compared with ACE inhibitor, SV new (HR: 0.18; 95% CI: 0.11-0.29) and ACE inhibitor-SV users (HR: 0.31; 95% CI: 0.23-0.43) showed lower risk of angioedema. On the other hand, there was no difference in angioedema risk when SV new users (HR: 0.59; 95% CI: 0.35-1.01) or ARB-SV users (HR: 0.85; 95% CI: 0.58-1.26) were compared with ARB new users. Compared with SV new users, ACE inhibitor-SV users (HR: 1.62; 95% CI: 0.91-2.89) trended toward higher angioedema risk, which intensified when the ACE inhibitor to SV switch occurred within 14 days (recent ACE inhibitor-SV) (HR: 1.98; 95% CI: 1.11-3.53). Similarly, ARB-SV users (HR: 2.03; 95% CI: 1.16-3.54) experienced an increased risk compared with SV new users, which intensified for the more recent switchers (recent ARB-SV) (HR: 2.45; 95% CI: 1.36-4.43). CONCLUSIONS: We did not observe an increased risk of angioedema among SV new users compared with ACE inhibitor or ARB users. However, there was an increased risk of angioedema among SV users who recently switched from ACE inhibitor or ARB compared with SV new users.
Eworuke et al. (Sun,) reported a cohort. Sacubitril-valsartan vs. ACE inhibitor or ARB was evaluated on angioedema (HR 0.18, 95% CI 0.11-0.29). Sacubitril-valsartan new users had a lower risk of angioedema compared with ACE inhibitor new users (HR 0.18; 95% CI 0.11-0.29), but recent switchers from ACEi or ARB to SV faced increased risk.