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).
TABLE OF CONTENTS
4 PRODUCT PROFILES
4 Vasotec : Chronic heart failure
LIST OF FIGURES
7 Figure 1: Vasotec for chronic heart failure – SWOT analysis
7 Figure 2: Datamonitor Healthcare’s drug assessment summary for Vasotec in chronic heart
failure
8 Figure 3: Datamonitor Healthcare’s drug assessment summary for Vasotec in chronic heart
failure
LIST OF TABLES
4 Table 1: Vasotec drug profile
6 Table 2: Vasotec pivotal trial data in chronic heart failure