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Pharmacokinetics and safety of sacubitril/valsartan (LCZ696) in patients with mild and moderate hepatic impairment 

Kenneth M. Kulmatycki, Thomas Langenickel, Wai Hong Ng, Parasar Pal, Wei Zhou, Tsu-Han Lin, Iris Rajman, Priyamvada Chandra, and Gangadhar Sunkara

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Volume 55 (2017) p. 728 - 739

Abstract

International Journal of Clinical Pharmacology and Therapeutics, Vol. 55 – No. 9/2017 (728-739)

Pharmacokinetics and safety of sacubitril/valsartan (LCZ696) in patients with mild and moderate hepatic impairment 

Kenneth M. Kulmatycki¹, Thomas Langenickel², Wai Hong Ng³, Parasar Pal⁴, Wei Zhou³, Tsu-Han Lin³, Iris Rajman², Priyamvada Chandra³, and Gangadhar Sunkara³

¹Novartis Institutes for Biomedical Research, Cambridge, MA, USA, ²Novartis Institutes for BioMedical Research, Basel, Switzerland,  ³Novartis Institutes for Biomedical Research, East Hanover, NJ, USA, and  ⁴Novartis Healthcare Pvt. Ltd., Hyderabad, Telangana, India
Objectives: To assess the protein binding and pharmacokinetics of sacubitril/valsartan analytes (sacubitril, sacubitrilat, and valsartan) in an open-label, single oral dose (200 mg), parallel-group study in patients with mild and moderate hepatic impairment (Child-Pugh class A and B) and matched healthy subjects. Methods: This study enrolled 32 subjects (n = 8 in each hepatic impairment and matched healthy subjects groups). Blood samples were collected at pre-determined time points to assess pharmacokinetics of sacubitril, sacubitrilat, and valsartan. Subjects with severe hepatic impairment were excluded as valsartan exposure is expected to be substantially increased in these patients. Results: Sacubitril exposure (AUC) increased by 53% and 245% while the exposure to sacubitrilat was increased by 48% and 90% in patients with mild and moderate hepatic impairment, respectively. Sacubitril C_max increased by 57% and 210% in mild and moderate hepatic impairment; however, for both sacubitrilat and valsartan, C_max was unchanged. Valsartan AUC increased in patients with mild and moderate hepatic impairment by 19 – 109%, respectively. Conclusions: The increase in systemic exposures to all sacubitril/valsartan analytes correlated with the severity of liver disease. The plasma unbound fraction of sacubitrilat in patients with moderate hepatic impairment was slightly higher than in matched healthy subjects. This difference was not considered clinically significant. Safety assessments showed that sacubitril/valsartan was safe and well tolerated across all the study groups. Correspondence to:
Kenneth M. Kulmatycki, PhD 
Novartis Institutes for Biomedical Research
220 Massachusetts Avenue, 342E
Cambridge, MA 02139, USA 
Email: [email protected]

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