Table 3.
Studies of Combination therapy of ARNI and SGLT2i in HF.
| Study | Number of studies included | Number of patients | Treatment groups | Outcomes |
|---|---|---|---|---|
| Jiménez-Blanco Bravo M, et al28 | consecutive, observational, retrospective, multicentre study conducted in 3 Heart Failure Units | 144 patients with HFrEF | Safety and efficacy of combination of ARNI and SGLT2i in HFrEF | Co-administration of SGLT2i and ARNI in routine care of HFrEF patients produced a slight decrease in eGFR at 6 months follow up. The decrease was significant in elderly patients. |
| Hsiao FC, et al29 | Multicenter study: During 2016 to 2018, patients with HFrEF and Type2 DM were identified from Chang Gung Research Database; a database deriving from the original electronic medical records of 7 hospitals in Taiwan. | 2312 patients between 2016 and 2018 of HFrEF and DM | 4 groups – SGLT2i + ARNI; SGLT2i; ARNI; No SGLT2i and no ARNI | Treatment with the combination of SGLT2 inhibitors and ARNI was well tolerated in diabetic patients with HFrEF and associated with lower risk of HHF. |
| Jariwala P, et al30 | Single centre retrospective analysis of 104 symptomatic patients of HFrEF despite of optimal medical management with ARNI between January–June 2020. | 104 symptomatic patients of HFrEF | SGLT2 inhibitors should be used in symptomatic refractory HFrEF patients despite use of ARNI. | |
| De Marzo V, et al31 | 69 trials metanalysis | 91,741 patients | step-wise introduction of ARNI, SGLT2i, IVA and/or Vericiguat to the disease-modifying neurohormonal inhibitors (ACEI/ARB, BB and MRA) were compared with placebo | the combination SGLT2i + ARNI + BB + MRA was associated with the lowest hazard ratio. |
| Xiang B, et al32 | 48 trials metanalysis | 68,074 patients | Monotherapies or combinations of ACEI, ARB, ARNI, BB, MRA, SGLT2i, IVA, and placebo | ARNI + BB + MRA, SGLT2i + ACEI + BB + MRA, and IVA + ACEI + BB + MRA were associated with significant reductions in the risk of all-cause death, CV mortality and HHF. |
Note:- ARNI: angiotensin receptor-neprilysin inhibitor, ACEI: angiotensin converting enzyme inhibitor; ARB: angiotensin receptor blocker; BB: beta blocker, MRA: mineralocorticoid receptor antagonist; SGLT2i: sodium-glucose cotransporter-2 inhibitor; HFrEF: heart failure with reduced ejection fraction; CV: cardiovascular; HHF: hospitalisation for heart failure: eGFR: estimated glomerular filtration rate: IVA: ivabradine; DM: Diabetes mellitus.