References

medsovet

Медицинский Совет

Meditsinskiy sovet = Medical Council

2079-701X2658-5790

REMEDIUM GROUP Ltd.

10.21518/2079-701X-2020-14-34-39

medsovet-5808

Research Article

СЕРДЕЧНАЯ НЕДОСТАТОЧНОСТЬ

HEART FAILURE

Комбинированный препарат сакубитрил/валсартан -новый этап в лечении хронической сердечной недостаточности

Combined drug sacubitril/valsartan -a new era of treatment of chronic heart failure

https://orcid.org/0000-0001-7862-0937

Никифоров

В. С.

Nikiforov

V. S.

Никифоров Виктор Сергеевич - доктор медицинских наук, профессор, профессор кафедры функциональной диагностики.

191015, Санкт-Петербург, ул. Кирочная, д. 41

Viktor S. Nikiforov - Dr. of Sci. (Med.), Professor, Professor of the Department of Functional Diagnostics.

41, Kirochnaya St., St Petersburg, 191015

viktor.nikiforov@szgmu.ru

Северо-Западный государственный медицинский университет им. И.И. МечниковаРоссияNorth-Western State Medical University named after I.I. MechnikovRussian Federation

2020

14102020

0143439

2020

Никифоров В.С.

Nikiforov V.S.

Данная работа распространяется под лицензией Creative Commons Attribution 4.0.

This work is licensed under a Creative Commons Attribution 4.0 License.

https://www.med-sovet.pro/jour/article/view/5808

В статье рассмотрены возможности применения для лечения хронической сердечной недостаточности (ХСН) препарата нового класса лекарственных средств - ингибитора рецепторов ангиотензина II/неприлизина - сакубитрила/валсартана. Подчеркнута роль системы натрийуретических пептидов в патогенезе ХСН и значение нейрогормональной модуляции в современной терапии пациентов с сердечной недостаточностью. Изложены стратегии введения экзогенных натрийуретических пептидов и блокирования разрушения натрийуретических пептидов в организме человека. Рассмотрены вопросы воздействия на фермент неприлизин, который участвует в метаболизме натрийуретических пептидов и ангиотензина II. В этой связи перспективным является одновременное ингибирование неприлизина с подавлением ренин-ангиотензиновой системы. Первым опытом в данном направлении стала разработка и изучение препарата омапатрилат. Представлены результаты многоцентровых исследований OVERTURE (Omapatrilat Versus Enalapril Randomized Trial of Utility in Reducing Events) и OCTAVE (Omapatrilat Cardiovascular Treatment vs. Enalapril). Препятствием к применению омапатрилата в клинической практике стала высокая частота развития ангионевротического отека. Для снижения риска этого осложнения был разработан комбинированный препарат LCZ696, состоящий из ингибитора неприлизина - сакубитрила (AHU377) и блокатора рецепторов ангиотензина II (БРА) - валсартана, который, в отличие от ингибиторов АПФ, не тормозит распад брадикинина. Наличие в составе Ц2696-веш,ества, действующего на систему нейтральных эндопептидаз, сделало данный препарат родоначальником нового класса лекарственных средств. Результаты исследования PARADIGM-HF (Prospective comparison of ARNI with ACEI to Determine Impact on Global Mortailty and morbidity in Heart Failure trial) послужили основанием для включения препарата сакубитрил/валсартан в 2016 г. в рекомендации ACC/AHA/HFSA и ESC, а позднее и в российские рекомендации. В статье рассмотрены современные подходы к применению препарата сакубитрил/валсартан.

The article describes the possibility of using a new class of angiotensin II/neprilysin receptor inhibitor - sacubitrile/valsartan for the treatment of chronic heart failure (CHF). The role of the natriuretic peptide system in the pathogenesis of CHF and the importance of neurohormonal modulation in modern therapy of patients with heart failure are emphasized. Strategies for introducing exogenous natriuretic peptides and blocking the destruction of natriuretic peptides in the human body are described. The questions of influence on the enzyme neprilysin, which is involved in the metabolism of natriuretic peptides and angiotensin II, are considered. In this regard, the simultaneous inhibition of non-lysine with the suppression of the renin-angiotensin system is promising. The first experience in this direction was the development and study of the drug omapatrilat. The results of multicenter studies of OVERTURE (Omapatrilat Versus Enalapril Randomized Trial of Utility in Reducing Events) and OCTAVE (Omapatrilat Cardiovascular Treatment vs. Enalapril) are presented. An obstacle for the use of omapatrilat in clinical practice was the high frequency of angioedema. To reduce the risk of this complication, a combined drug LCZ696 was designed, consisting of a neprilysin inhibitor - sacubitrile (AHU377) and an angiotensin II receptor blocker (ARB) - valsartan, which, unlike ACE inhibitors, does not inhibit the breakdown of bradykinin. The presence in the composition of LCZ696 of a substance acting on the system of neutral endopeptidases, made this drug the first of a new class of drugs. The results of the PARADIGM-HF study (Prospective comparison of ARNI with ACEI to Determine Impact on Global Mortality and morbidity in Heart Failure trial) served as the basis for including the drug sacubitril/valsartan in 2016 in the ACC/AHA/HFSA and ESC guidelines, and later in the Russian recommendations. The article discusses modern approaches to the use of the drug sacubitril/valsartan.

сердечная недостаточностьсакубитрил/валсартаннеприлизиннатийуретические пептидыренин-анги-отензин-альдостероновая система

heart failuresacubitril/valsartanneprilysinnatriuretic peptidesrenin-angiotensin-aldosteron system

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The authors declare that there are no conflicts of interest present.