Recent switch from ARB, ACE inhibitor to sacubitril/valsartan ups risk of angioedema

New users of sacubitril-valsartan (SV) show no increased risk of angioedema when compared to users of angiotensin-converting enzyme (ACE) inhibitor and angiotensin receptor blocker (ARB), reports a study.

However, SV users who recently switched from ACE inhibitor or ARB are at higher risk of angioedema than SV new users.

A team of investigators performed a propensity score‒matched cohort study to compare SV new users (no use of SV, ACE inhibitor, or ARB 6 months prior) and SV new users with prior use (within 183 or 14 days) of ACE inhibitor or ARB (ACE inhibitor–SV and ARB-SV users; recent ACE inhibitor–SV, and recent ARB‒SV users, respectively) compared with ACE inhibitor and ARB new users separately.

Angioedema risk was lower among SV new users (hazard ratio [HR], 0.18, 95 percent confidence interval [CI], 0.11‒0.29) and ACE inhibitor‒SV users (HR, 0.31, 95 percent CI, 0.23‒0.43) compared with ACE inhibitor users. No difference was seen in angioedema risk when comparing SV new users (HR, 0.59, 95 percent CI, 0.35‒1.01) or ARB‒SV users (HR, 0.85, 95 percent CI, 0.58‒1.26) with ARB new users.

ACE inhibitor‒SV users appeared to have a higher risk of angioedema (HR, 1.62, 95 percent CI, 0.91‒2.89) compared with SV new users. Such risk further increased when the switch from ACE inhibitor to SV occurred within 14 days (HR, 1.98, 95 percent CI, 1.11‒3.53).

Likewise, ARB‒SV users had an increased risk (HR, 2.03, 95 percent CI, 1.16‒3.54) compared with SV new users. This risk also intensified for the more recent switchers (HR, 2.45, 95 percent CI, 1.36‒4.43).