Long-Term Use of Sacubitril/Valsartan in Stage C and Stage D Canine Myxomatous Mitral Valvular Disease

Abstract:

Background: Sacubitril/valsartan (Entresto®) is a first in class ARNi that, in human medicine, significantly decreases cardiac death and heart failure hospitalization compared to ACEi.
Hypothesis: ARNi therapy provides benefit to canine patients with CHF secondary to MMVD.
Animals: Fifty canines from a single institution in ACVIM stage C or D of MMVD were retrospectively evaluated for echocardiographic parameters, serum biochemical measures, systemic blood pressure, survival time from first CHF episode, and survival time while receiving sacubitril/valsartan.

Results: Serum BUN levels at time of prescription (median 35.5mg/dL (22.8-45.5mg/dL) was not statistically significantly different compared to 7-14 days on sacubitril/valsartan therapy (31.5mg/dL (23-45mg/dL)). Similar findings were evident when comparing serum creatinine levels at time of prescription (1.2 mg/dL (IQR 0.9-1.63mg/dL)) and 7-14 days after treatment ((1.1mg/dL (IQR 0.8-1.5mg/dL)). The difference in systolic blood pressure at time of prescription (130.3mmHg (SD 15.4)) and 7-14 days (132mmHg (IQR 110-142)) was not statistically significant. The median survival time of all dogs from time of first episode of CHF to all-cause mortality was 577 (431; 751) days. When grouping dogs based upon ACVIM stage C or D, median survival time was 1149 (570; infinity) days for stage C and 446.5 (283; 619) days for stage D. The median survival time of patients while receiving sacubitril/valsartan (total time on ARNi therapy) was 348 days (254; 478;)

Conclusion: Based on this retrospective case series, ARNi therapy with sacubitril/valsartan in dogs appears safe and suggests median survival times that eclipse those of prior canine stage C or D MMVD.