Are all angiotensin receptors blockers the same?

Br J Cardiol 2010;17:s2 Leave a comment
Click any image to enlarge
Sponsorship Statement: This supplement has been sponsored by Takeda UK Ltd. Sponsorship included all print and production costs of the supplement, plus support of the meeting where the discussions took place and support in the writing of the papers. Takeda UK Ltd did not take part in the discussions held at the meeting and editorial control of this supplement resides with the authors and the journal. The supplement underwent peer review and was also reviewed by the faculty and Takeda UK Ltd for accuracy.

This supplement is based on the proceedings of a one-day round-table meeting held on 20th February 2010 to debate whether angiotensin receptor blockers (ARBs) have a class effect or whether they show different efficacy and safety profiles and so should be selected and used on an individual basis. The round-table meeting was initiated and funded by Takeda UK Ltd.

With the patent expiry of the first-in-class ARB, losartan, in March 2010, it is important to decide whether all ARBs are interchangeable since the availability of generic losartan at a price that could be perceived as attractive to primary care trusts (PCTs) and prescribers may result in pressure on physicians to switch patients onto the cheapest generic ARB available. Also, the recent EU Directive 2001/83/EC provides a mechanism for harmonisation of drug labelling for drugs across countries within the EU: this might imply that all ARBs are interchangeable, thus reinforcing the use of a cheaper generic ARB in all clinical situations.

The key conclusion from this meeting was that the evidence base for ARBs varies for the different drugs in this class. Therefore, assuming a class effect may not optimise management decisions for individual patients. Different ARBs have differing pharmacological effects, with potentially different efficacy profiles. Randomised trial evidence differs for the various drugs in this class and so they should not be used interchangeably. The ARB used in a particular setting should be selected based on clinical trial evidence for its use rather than solely on cost considerations.  The papers in this supplement provide the evidence for these conclusions and provide guidance for the physician in selecting the most appropriate ARB for various clinical situations.

Conflict of interest

MC provides consultancy advice to a number of pharmaceutical and device companies, including Takeda UK Ltd. He holds no stocks or shares in any such company.

Disclaimer: UK prescribing information current at the date of publication of this supplement can be found by downloading the PDF. Medinews Cardiology Limited advises healthcare professionals to consult up-to-date Prescribing Information and the full Summary of Product Characteristics available from the manufacturers before prescribing any product. Medinews Cardiology Limited cannot accept responsibility for any errors in prescribing which may occur.