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Dr Pratim Sengupta, Kolkata 12 January 2018

Neprilysin inhibition acts by inhibiting the breakdown of natriuretic peptides and increasing their bioavailability, which brings about diuresis and sodium excretion eventually resulting in suppressing of the renin-angiotensin-aldosterone system (RAAS). RAAS inhibition triggers a series of counter regulatory effects, which balances the adverse effects present in CKD and HF.
LCZ696 (Sacubitril/Valsartan) is a new combination drug with the dual effect of inhibitory effect on the Neprilysin receptor as well as on the angiotensin II receptor. In a landmark trial Paradigm HF, Sacubitril Valsartan showed significant 20% mortality and hospitalization reduction in HFrEF.
Interestingly, in Paradigm HF, increase in serum creatinine and serum potassium was also less compared to ACE inhibitor. Sacubitril valsartan is a promising candidate for the treatment of arterial hypertension and heart failure. It is expected to have similar potential in the treatment of CKD patients, especially those with macroproteinuria.

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