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NCT02816736: HFN-LIFE

EntrestoTM (LCZ696) In Advanced Heart Failure (LIFE Study)

Completed Phase 4 Results posted Last updated 3 December 2021
What this trial tests

Phase 4 trial testing LCZ696 in Heart Failure in 365 participants. Completed in 29 September 2020.

Timeline
2 March 2017
Primary endpoint
15 September 2020
29 September 2020

Quick facts

Lead sponsorDuke University
PhasePhase 4
StatusCompleted
Study typeINTERVENTIONAL
Allocationrandomized
Designparallel
Maskingtriple
Primary purposetreatment
Enrollment365
Start date2 March 2017
Primary completion15 September 2020
Estimated completion29 September 2020
Sites38 locations across United States

Drugs / interventions tested

Conditions studied

Sponsor

Duke University

Who can join

Adults 18 to 85, any sex, with Heart Failure. Patients with the condition only — healthy volunteers not accepted.

Results — posted to ClinicalTrials.gov

Per-arm endpoint measurements with 95% confidence intervals where reported. Source: trial results section.

Change in NT-proBNP Primary · Baseline, 2, 4, 8, 12, and 24 weeks

The proportional change from baseline in the AUC for NT-proBNP levels measured at 2, 4, 8, 12, and 24 weeks. AUC was normalized for time and divided by the baseline value of NTproBNP so it has no unitshas no units. With the log-scale, the value of 0 indicates, on average, no change in NTproBNP from baseline. A value \> 0 indicates an increase in log NT Pro BNP relative to baseline and a value \< 0 indicates a decrease in log NT Pro BNP relative to baseline.

GroupValue95% CI
LCZ696 (Entresto) + Placebo0.14± 0.65
Valsartan + Placebo0.19± 0.50
Composite Endpoint of the Effects of LCZ696 (Number of Days) Secondary · Randomization through 24 weeks

Composite endpoint of effects of LCZ696 compared to valsartan over 24 weeks will be compared based upon the number of days subjects are * alive and out of hospital * not listed for transplant (Status 1A, 1B or 1-4), or undergoing transplant * not implanted with an LVAD * not maintained or started on continuous inotropic therapy for ≥ 7 days * not hospitalized twice for HF (following the index admission) The days alive and out of hospital will end on the day of the second HF readmission, if applicable.

GroupValue95% CI
LCZ696 (Entresto) + Placebo108.5895.22 – 121.95
Valsartan + Placebo119.8107.64 – 131.96
Tolerability - Target Dose Secondary · Randomization through 24 weeks

Tolerability as measured by number of subjects achieving a target dose of 0% (stopped study drug early or was never started on study drug), 25%, 50% or 100% of valsartan or LCZ696 (based on last dose of study drug taken prior to end of study)

GroupValue95% CI
LCZ696 (Entresto) + Placebo49
Valsartan + Placebo37
LCZ696 (Entresto) + Placebo28
Valsartan + Placebo41
LCZ696 (Entresto) + Placebo33
Valsartan + Placebo30
LCZ696 (Entresto) + Placebo57
Valsartan + Placebo60
Tolerability - Hypotension Secondary · Randomization through 24 weeks

Tolerability as measured by number of subjects developing hypotension (SBP ≤ 85 mmHg) with symptoms

GroupValue95% CI
LCZ696 (Entresto) + Placebo29
Valsartan + Placebo20
LCZ696 (Entresto) + Placebo138
Valsartan + Placebo148
Tolerability - Renal Function Secondary · Randomization through 24 weeks

Tolerability as measured by number of subjects developing worsening renal function (eGFR \< 20 ml/min/1.73 m²)

GroupValue95% CI
LCZ696 (Entresto) + Placebo7
Valsartan + Placebo7
LCZ696 (Entresto) + Placebo160
Valsartan + Placebo161
Tolerability - Hyperkalemia Secondary · Randomization through 24 weeks

Tolerability as measured by number of subjects developing moderate (\>/= 5.5 mmol/L-5.9 mmol/L) or severe (\>/= 6 mmol/L) hyperkalemia

GroupValue95% CI
LCZ696 (Entresto) + Placebo28
Valsartan + Placebo15
LCZ696 (Entresto) + Placebo139
Valsartan + Placebo153

Adverse events — posted to ClinicalTrials.gov

Time frame: Randomization to week 24. Reporting threshold: 5%. Adverse-event reports describe events observed during the trial — not all are caused by the drug.

LCZ696 (Entresto) + Placebo
Serious: 43/167 (26%)
Deaths: 13/167
Valsartan + Placebo
Serious: 27/168 (16%)
Deaths: 8/168

Serious adverse events (89 terms)

ReactionSystemLCZ696 (Entresto) + PlaceboValsartan + Placebo
Multiple Organ Dysfunction SyndromeGeneral disorders
PneumoniaInfections and infestations
Urinary Tract ObstructionRenal and urinary disorders
Respiratory FailureRespiratory, thoracic and mediastinal disorders
CoagulopathyBlood and lymphatic system disorders
Gastrointestinal HaemorrhageGastrointestinal disorders
PyrexiaGeneral disorders
SepsisInfections and infestations
Septic ShockInfections and infestations
DehydrationMetabolism and nutrition disorders
HyperglycaemiaMetabolism and nutrition disorders
HypokalaemiaMetabolism and nutrition disorders
Adenocarcinoma of ColonNeoplasms benign, malignant and unspecified (incl cysts and polyps)
Vaginal HaemorrhageReproductive system and breast disorders
Chronic Obstructive Pulmonary DiseaseRespiratory, thoracic and mediastinal disorders
EpistaxisRespiratory, thoracic and mediastinal disorders
Mediastinal HaematomaRespiratory, thoracic and mediastinal disorders
Diabetic ulcerSkin and subcutaneous tissue disorders
HaematomaVascular disorders
HypotensionVascular disorders
Peripheral IschaemiaVascular disorders
Shock HaemorrhagicVascular disorders
AnaemiaBlood and lymphatic system disorders
Haemorrhagic AnaemiaBlood and lymphatic system disorders
LeukocytosisBlood and lymphatic system disorders

Most-reported serious reactions: Multiple Organ Dysfunction Syndrome, Pneumonia, Urinary Tract Obstruction, Respiratory Failure, Coagulopathy, Gastrointestinal Haemorrhage, Pyrexia, Sepsis.

Data from ClinicalTrials.gov NCT02816736 adverse events section.

Sponsor's own description

The primary objective of the study is to determine whether, in patients with symptomatic, advanced heart failure due to left ventricular systolic dysfunction, treatment with LCZ696 for 24 weeks will improve Pro-B-type Natriuretic Peptide (NT-proBNP) levels, which reflect hemodynamic and clinical status, compared to treatment with valsartan.

Publications & conference data

8 peer-reviewed publications reference this trial (live from Europe PMC):

  1. Initiation, Continuation, Switching, and Withdrawal of Heart Failure Medical Therapies During Hospitalization.
    Bhagat AA, Greene SJ, Vaduganathan M, Fonarow GC, et al · · 2019 · cited 126× · PMID 30414818 · DOI 10.1016/j.jchf.2018.06.011
  2. Effect of Treatment With Sacubitril/Valsartan in Patients With Advanced Heart Failure and Reduced Ejection Fraction: A Randomized Clinical Trial.
    Mann DL, Givertz MM, Vader JM, Starling RC, et al · · 2022 · cited 120× · PMID 34730769 · DOI 10.1001/jamacardio.2021.4567
  3. Practical guidance on the use of sacubitril/valsartan for heart failure.
    Sauer AJ, Cole R, Jensen BC, Pal J, et al · · 2019 · cited 72× · PMID 30565021 · DOI 10.1007/s10741-018-9757-1
  4. Sacubitril/Valsartan in Advanced Heart Failure With Reduced Ejection Fraction: Rationale and Design of the LIFE Trial.
    Mann DL, Greene SJ, Givertz MM, Vader JM, et al · · 2020 · cited 38× · PMID 32641226 · DOI 10.1016/j.jchf.2020.05.005
  5. New perspectives and future directions in the treatment of heart failure.
    Pellicori P, Khan MJI, Graham FJ, Cleland JGF. · · 2020 · cited 32× · PMID 31327116 · DOI 10.1007/s10741-019-09829-7
  6. Potential Expanded Indications for Neprilysin Inhibitors.
    Riddell E, Vader JM. · · 2017 · cited 22× · PMID 28281174 · DOI 10.1007/s11897-017-0327-y
  7. ARNi: A Novel Approach to Counteract Cardiovascular Diseases.
    Volpe M, Rubattu S, Battistoni A. · · 2019 · cited 21× · PMID 31035359 · DOI 10.3390/ijms20092092
  8. Tolerability of Sacubitril/Valsartan in Patients With Advanced Heart Failure: Analysis of the LIFE Trial Run-In.
    Vader JM, Givertz MM, Starling RC, McNulty SE, et al · · 2022 · cited 17× · PMID 35772853 · DOI 10.1016/j.jchf.2022.04.013

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