Singapore approves new heart failure drug

Mr Chew says that he used to get breathless from just walking a very short distance. But after taking Entresto, the 70-year-old "can walk up to 20 minutes and even climb the stairs".
Mr Chew says that he used to get breathless from just walking a very short distance. But after taking Entresto, the 70-year-old "can walk up to 20 minutes and even climb the stairs".ST PHOTO: MARK CHEONG

A new heart failure drug that is more effective than existing ones in reducing the risk of death and hospitalisation has been approved for use here.

It was passed by the Health Sciences Authority last month, after a successful worldwide trial between 2009 and 2013.

At a press briefing yesterday, doctors said they believe the drug, called Entresto, represents a significant leap from past heart failure drugs.

Adjunct Assistant Professor David Sim, director of the Heart Failure Programme at the National Heart Centre Singapore (NHCS), said: "Even with existing drugs for chronic heart failure, prognosis remains fairly poor.

"But this drug reduces both risk of death as well as hospitalisation, so both mortality and morbidity. Some drugs reduce one but not the other, but this one does both."

The trial involved 47 countries and 8,442 patients with chronic heart failure and reduced ejection fraction - where the heart muscle does not contract effectively and less oxygen-rich blood is pumped out to the body.

NHCS, Khoo Teck Puat Hospital, Tan Tock Seng Hospital and National University Heart Centre took part in this trial, which involved 32 patients from Singapore.

It was found that patients given Entresto instead of the current "gold standard" drug enalapril had their risk of cardiovascular death cut by 20 per cent, and hospitalisation due to heart failure cut by 21 per cent. The risk of death as a result of all causes was lessened by 16 per cent.

In absolute terms, it means that for every 1,000 patients who switched to the new drug, 31 deaths were avoided, said Prof Sim.

Entresto works by suppressing overactivated harmful neurohormones, which have bad effects on the body, while boosting the good neurohormones, which might be underactivated.

Total deaths from cardiovascular disease hit 5,799 in 2014, or 29.9 per cent of all deaths that year, going by Ministry of Health figures.

Dr Raymond Wong, senior consultant of the department of cardiology at National University Heart Centre, noted that there were more than 6,000 hospital admissions for heart failure here last year.

It is also the second most common condition for early rehospitalisation after discharge, after the condition of chronic obstructive pulmonary disease and asthma, he added.

Entresto is manufactured by pharmaceutical giant Novartis at its Singapore plant in Tuas. Worldwide shipping of the drug started last month, said Novartis.

NHCS started prescribing the drug to specific patients from last November. One of them, retiree Chew Bak Mok, 70, said: "Last year, I started becoming very breathless when I walk a very short distance, like 30m. After taking this drug, I can walk up to 20 minutes and even climb the stairs."

A Novartis spokesman said it is now working with all hospitals and doctors to make the drug available to all heart failure patients here.

A version of this article appeared in the print edition of The Straits Times on March 15, 2016, with the headline 'S'pore approves new heart failure drug'. Print Edition | Subscribe