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The role of tolvaptan add-on therapy in patients with acute heart failure: a systematic review and network meta-analysis.
Pratama, Vireza; Budiono, Jordan; Thobari, Jarir At; Widyantoro, Bambang; Anggraeni, Vita Yanti; Dinarti, Lucia Kris.
Afiliación
  • Pratama V; Faculty of Medicine Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
  • Budiono J; Department of Cardiology, Gatot Soebroto Central Army Hospital (RSPAD), Jakarta, Indonesia.
  • Thobari JA; Department of Cardiology and Vascular Medicine, Faculty of Medicine and Health Science, Universitas Pertahanan Republik Indonesia, Bogor, Indonesia.
  • Widyantoro B; Faculty of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia.
  • Anggraeni VY; Department of Pharmacology and Therapy, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
  • Dinarti LK; Clinical Epidemiology and Biostatistic Unit (CEBU), Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
Front Cardiovasc Med ; 11: 1367442, 2024.
Article en En | MEDLINE | ID: mdl-38873266
ABSTRACT

Background:

Several conflicting reviews have concluded that the use of loop diuretics is associated with poorer clinical and safety outcomes. Therefore, this study aimed to investigate the efficacy and safety of tolvaptan as an adjunct to conventional diuretic therapy in patients with acute heart failure (AHF).

Methods:

A comprehensive search was conducted on PubMed, Embase, ProQuest, EBSCO, and Cochrane Library until 24 May 2023 to identify randomized controlled trials that compared the effects of tolvaptan with conventional therapy and placebo in patients with AHF. The quality assessment of the included trials was conducted using the Cochrane risk of bias. A network meta-analysis (NMA) was conducted to examine the dosage effect of tolvaptan.

Result:

A total of 17 studies with 18 reports, involving 10,039 patients, were selected. The tolvaptan add-on therapy significantly alleviated dyspnea [24 h RR 1.16 (1.04, 1.29), 48 h RR 1.18 (1.04, 1.33)], reduced body weight within 48 h [Asian group, MD -0.93 (-1.48, -0.38); non-Asian group, MD -2.76 (-2.88, -2.65)], reduced edema [RR 1.08 (1.02, 1.15)], increased serum sodium [non-Asian group, MD 3.40 (3.02, 3.78)], and resulted in a change in serum creatinine [MD -0.10 (-0.18, -0.01)]. No significant differences were observed in mortality and rehospitalization. The NMA suggested that an intermediate dosage (15 mg/day) might offer the best efficacy in reducing dyspnea within 24 h, reducing edema, increasing serum sodium, and lowering the incidence of worsening renal function (WRF).

Conclusion:

In conclusion, the meta-analysis showed that tolvaptan contributed to the short-term alleviation of congestive symptoms, elevated sodium levels, and a lower incidence of WRF. However, no significant benefits were observed in long-term symptoms, rehospitalization rates, and mortality. An intermediate dosage of tolvaptan might be considered the optimal choice for various clinical outcomes. Systematic Review Registration https//www.crd.york.ac.uk/, PROSPERO (CRD42023420288).
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Front Cardiovasc Med Año: 2024 Tipo del documento: Article País de afiliación: Indonesia Pais de publicación: Suiza
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Front Cardiovasc Med Año: 2024 Tipo del documento: Article País de afiliación: Indonesia Pais de publicación: Suiza