Entresto (a tablet comprising a combination of the drugs sacubitril and valsartan), is in clinical development for people with chronic heart failure with preserved ejection fraction. Heart Failure (HF) is a complex clinical syndrome of symptoms and signs that suggest the efficiency of the heart as a pump is impaired. Symptoms include breathlessness and fatigue, and signs of the condition include swollen ankles and crackling sounds in the lungs. People with HF often have a poor quality of life, and about a third of people experience severe and prolonged depressive illness. About half of people with HF have a preserved ejection fraction (HF-PEF), meaning that over 50% of the blood in the left ventricle is pumped out with each contraction of the heart.
Entresto is licensed in the UK for treating people with HF with a reduced ejection fraction. The drug combination works by augmenting the actions of natriuretic peptides, which defend the heart from volume and pressure overload. Trials have shown that treatment with Entresto can reduce pressure and wall stress in the left ventricle. If licensed, Entresto could provide a treatment for people with HF-PEF, who currently have no effective treatments available.
Rivaroxaban is an already approved oral medicine used for the prevention of thrombotic vascular events in different types of artery diseases including PAD. It acts by blocking specific pathways involved in the process of blood clots within blood vessels, reducing the risk of a major vascular event. Aspirin alone is the current standard treatment in patients with PAD undergoing revascularization procedures but its risk reduction may not be adequate. If licensed rivaroxaban will potentially be an option as an add-on therapy in this patient group.