Relative efficacy of spironolactone, eplerenone, and cAnRenone in patients with chronic heart failure (RESEARCH)

• Verfasst von: Frankenstein, Lutz [VerfasserIn]
• Verfasst von: Seide, Svenja [VerfasserIn]
• Verfasst von: Täger, Tobias [VerfasserIn]
• Verfasst von: Jensen, Katrin [VerfasserIn]
• Verfasst von: Fröhlich, Hanna [VerfasserIn]
• Verfasst von: Clark, Andrew L. [VerfasserIn]
• Verfasst von: Seiz, Mirjam [VerfasserIn]
• Verfasst von: Katus, Hugo [VerfasserIn]
• Verfasst von: Nee, Paul [VerfasserIn]
• Verfasst von: Uhlmann, Lorenz [VerfasserIn]
• Verfasst von: Naci, Huseyin [VerfasserIn]
• Verfasst von: Atar, Dan [VerfasserIn]
• Titel: Relative efficacy of spironolactone, eplerenone, and cAnRenone in patients with chronic heart failure (RESEARCH)
• Titelzusatz: a systematic review and network meta-analysis of randomized controlled trials
• Verf.angabe: Lutz Frankenstein, Svenja Seide, Tobias Täger, Katrin Jensen, Hanna Fröhlich, Andrew L. Clark, Mirjam Seiz, Hugo A. Katus, Paul Nee, Lorenz Uhlmann, Huseyin Naci, Dan Atar
• E-Jahr: 2020
• Jahr: [2020]
• Umfang: 11 S.
• Fussnoten: Published online: 30 July 2019 ; Gesehen am 14.04.2020
• Titel Quelle: Enthalten in: Heart failure reviews
• Ort Quelle: Dordrecht [u.a.] : Springer Science + Business Media B.V, 1996
• Jahr Quelle: 2020
• Band/Heft Quelle: 25(2020), 2, Seite 161-171
• ISSN Quelle: 1573-7322
• DOI: doi:10.1007/s10741-019-09832-y
• Datenträger: Online-Ressource
• Sprache: eng
• K10plus-PPN: 1694495183

Abstract

This study aims to assess the comparative benefit and risk profile of treatment with mineralocorticoid receptor antagonists (MRAs) with regard to all-cause mortality (primary endpoint), cardiovascular mortality, or heart failure (HF)-related hospitalization (secondary endpoints) and the safety endpoints hyperkalemia, acute renal failure, and gynecomastia in patients with chronic HF. We conducted a systematic review and network meta-analysis following PRISMA-P and PRISMA-NMA guidelines. From 16 different sources, 14 randomized controlled trials totaling 12,213 patients testing an active treatment of either spironolactone, eplerenone, or canrenone/potassium-canreonate in adults with symptomatic HF due to systolic dysfunction reporting any of the above endpoints were retained. Efficacy in comparison to placebo/standard medical care with respect to all-cause mortality was confirmed for spironolactone and eplerenone while no conclusion could be drawn for canrenone (HR 0.69 (0.62; 0.77), 0.82 (0.75; 0.91), and 0.50 (0.17; 1.45), respectively). Indirect comparisons hint a potential (non-significant) preference of spironolactone over eplerenone (HR 0.84 (0.68; 1.03)). The overall risk of bias was low to intermediate. Results for secondary endpoints as well as sensitivity analyses essentially mirrored these findings. The beta-blocker adjusted meta-analysis for the primary endpoint showed the same tendency as the unadjusted one (HR 0.39 (0.07; 2.03)). Results need to be interpreted with caution, though, as the resultant mix of patient- and study-level covariates produced unstable statistical modeling. We found no significant and systematic superiority of either MRA regarding efficacy toward all endpoints considered in both direct and indirect comparisons.