In the trial, 11% of patients received sacubritril-valsartan, and the primary-endpoint reduction compared with placebo in this subgroup was 26%, compared with 25% for patients treated with an ACE inhibitor or ARB. Currently, labeling for sacubitril-valsartan calls for starting a patients on an ACE inhibitor or ARB, titrating them to a stable and effective dosage, and then stopping this regimen to switch to the ARNI. If dapagliflozin is also added, then a simpler approach would be to just start a patient on ARB, optimize the dosage, and then start dapagliflozin (or an ARB-dapagliflozin combination) achieve the same benefit as from sacubitril-valsartan plus dapagliflozin. Could this be a future area of validation?
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