Vasotec

Analyst Outlook

Vasotec’s (enalapril; Merck & Co/Valeant) role in chronic heart failure (CHF) is severely limited by

competition from generic equivalents. Vasotec was the first angiotensin-converting enzyme (ACE)

inhibitor to demonstrate a reduction in CHF mortality, which led to its widespread use at first-line. It

is also a key comparator in late-stage CHF clinical trials. Despite a favorable clinical profile, Vasotec’s

commercial value is now limited by widespread generic competition following the expiry of key

patents in 2000. Vasotec will also experience significant competition from the recently launched

Entresto (valsartan/sacubitril; Novartis), which has demonstrated superior ability to improve

cardiovascular (CV) outcomes in CHF patients with reduced ejection (HFrEF). Based on these results,

the US and EU treatment guidelines now recommend Entresto as the first-line treatment option for

HFrEF patients, with the drug expected to replace Vasotec as the current standard of care.

Drug Overview

Vasotec is the prodrug of the ACE inhibitor enalaprilat. The inhibition of ACE leads to the suppression

of the renin-angiotensin-aldosterone system by preventing the formation of angiotensin II from

inactive angiotensin I. Angiotensin II is a potent vasoconstrictor that additionally stimulates

aldosterone secretion. A decrease in its levels lowers blood pressure and cardiac afterload (Valeant,

2014).