More effective heart failure drug gets OK for use in Singapore

RISK REDUCING: Retiree Chew, 70, who suffers from heart failure, found that he was able to walk more and climb stairs after taking Entresto.

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 (HSA) last month, after a successful worldwide trial between 2009 and 2013, which Singapore took part in.

At a press briefing yesterday, doctors said they believe that the drug, called Entresto, represents a significant leap over 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," he added.

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 the National University Heart Centre took part in this trial, which involved 32 patients from Singapore.

Patients given Entresto, instead of current "gold standard" drug enalapril, had their risk of cardiovascular death cut by 20 per cent, and hospitalisation due to heart failure reduced by 21 per cent.

The risk of death 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 over-activated harmful neuro-hormones while boosting the good neuro-hormones.

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.

Raymond Wong, senior consultant of the department of cardiology at the 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 re-hospitalisation 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 from last month, said Novartis.

NHCS has already started prescribing the drug.

Between November last year and February this year, it gave 60 patients the drug on a named-patient basis ahead of its official launch and distribution. Under the named patient scheme, physicians can apply to the HSA to import unregistered medicines for specific patients.

Retiree Chew Bak Mok, 70, was one of the patients. "Last year, I started becoming very breathless when I walked a very short distance, like 30m.

"After taking this drug, I can walk up to 20 minutes and even climb the stairs."

Under the named patient basis, he pays $135 per box of 30 tablets, with two tablets to be taken a day.

However, a Novartis spokesman said the official price is still under review. Currently, it is working with all hospitals and doctors to make the drug available to all heart failure patients in Singapore.