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2018 ; 35
(5
): 604-618
Nephropedia Template TP
gab.com Text
Twit Text FOAVip
Twit Text #
English Wikipedia
Efficacy and Safety of Zofenopril Versus Ramipril in the Treatment of Myocardial
Infarction and Heart Failure: A Review of the Published and Unpublished Data of
the Randomized Double-Blind SMILE-4 Study
#MMPMID29667144
Borghi C
; Omboni S
; Novo S
; Vinereanu D
; Ambrosio G
; Ambrosioni E
Adv Ther
2018[May]; 35
(5
): 604-618
PMID29667144
show ga
Zofenopril is a lipophilic, sulfhydryl group-containing angiotensin-converting
enzyme (ACE)-inhibitor, characterized by wide tissue distribution, long duration
of action, and pleiotropic effects on endothelial dysfunction. Its clinical
efficacy and safety have been described in the four randomized controlled trials
of the SMILE program, which globally enrolled more than 3600 patients in
post-acute myocardial infarction (AMI) setting. The SMILE-4 study specifically
selected patients with left ventricular dysfunction at admission, and compared
the effects of zofenopril or ramipril in combination with acetylsalicylic acid
(ASA). Zofenopril demonstrated its superiority over ramipril in reducing the
combined occurrence of death or hospitalization for cardiovascular causes both in
the overall population included in the original study and in subgroups of
patients at highest risk, namely hypertensive and diabetic subjects. The effects
of the early treatment with zofenopril were sustained over time, and, after
5 years of follow-up, zofenopril increased the survival likelihood and reduced
the hospitalization rate. Compared to ramipril, zofenopril was cost-effective
with a number to treat of 13 and an incremental cost-effectiveness ratio (ICER)
of 2125.45 euros for any additional event prevented. Furthermore, in real-world
settings, zofenopril decreased the risk of death in patients with heart failure,
particularly in men, and in subjects older than 76 years or with ejection
fraction lower than 54%. These results support the early use of zofenopril
immediately after AMI, even in the presence of comorbidities, and its maintenance
over time to reduce the risk of heart failure. FUNDING: Menarini International
Operations Luxembourg S.A.