New Heart Failure Drugs Offer More Therapy Options

by Jane Anderson 

Treatment for heart failure still relies significantly on tried-and-true generic drugs, but new brand-name entrants — including Novartis' Entresto (sacubitril/valsartan) and Amgen's Corlanor (ivabradine) — are important additions to prescribers' clinical arsenals against the high-mortality condition, industry insiders say.

"Generic heart failure drugs, including beta blockers, ACE inhibitors, and ARBs [angiotension receptor blockers] have historically been used and continue to be the backbone of therapy," says April Kunze, Pharm.D., senior director of clinical program development for Prime Therapeutics. "However, in the past few years, additional treatment options have become available. Entresto is now recommended as a first-line treatment option in patients with an ejection fraction <= 40%."

Novartis said Feb. 16 that Entresto won an expanded indication from the FDA to reduce the risk of cardiovascular death and hospitalization in adult patients with chronic heart failure. "Benefits are most clearly evident in patients with left ventricular ejection fraction (LVEF) below normal," the drugmaker said.

Prime Therapeutics currently prefers Entresto on formulary, and the PBM recommends that plans remove prior authorizations for Entresto in order to encourage its use, Kunze says.

Mesfin Tegenu, CEO and chairman of RxParadigm, says that Entresto, which has an average retail price of around $600 per month, typically is placed on formularies as a preferred brand drug. Meanwhile, Amgen's Corlanor can be beneficial in reducing heart failure-associated hospitalization for patients with symptomatic (NYHA Class II-III) stable chronic heart failure with a left ventricular ejection fraction of less than or equal to 35% who are receiving a maximal tolerated targeted dose of a beta blocker and in sinus rhythm with a heart rate of 70 beats per minute or greater at rest, Tegenu says.

"The target for Colanor is to slow down heart rate," Tegenu explains, adding that Corlanor typically is placed on formularies as a preferred or non-preferred brand, and may be started when the patient's condition is not being adequately controlled on optimally dosed beta blocker therapy.

Entresto and Corlanor represent advances in treatment for chronic heart failure, Tegenu says. "Both therapies were poised to change the landscape of treatment for patients with heart failure, given their unique mechanisms of action," he says.

Health plans also are turning to targeted disease and care management programs to focus on preventing hospital readmission, reducing mortality and reducing costs in heart failure, Tegenu adds.

From RADAR on Drug Benefits