Tolvaptan for Heart Failure
Published Date: 19th July 2016
Publication Authors: Tridente A
Abstract
The vasopressin type 2 receptor antagonist tolvaptan (TLV) is available to treat congestion in patients with heart failure (HF). However, there is paucity of evidence guiding its use, and lack of evidence of its long term efficacy.
Our objectives are to perform a systematic review of studies examining tolvaptan's effects in patients with HF; and a quantitative meta-analysis comparing primary and secondary outcomes between tolvaptan and placebo.
Only double-blinded randomised controlled trials, with no restriction on the language or the time of publication, were included. Our main outcome measures were all cause mortality, change in body weight, change in urine volume and change in serum sodium.
Extracted summary estimates included mean difference (MD) and standard deviation (SD) for change in body weight, change in urine volume and change in serum sodium levels, and hazard ratio with 95% confidence interval for all cause mortality.
We found eight double blinded randomised controlled trials (RCTs), seven of which were included in this meta-analysis. Assessment of risk of bias was conducted by investigating random sequence generation, allocation concealment, blinding, completeness of outcome data and potential for selective reporting. We found no evidence of significant bias.
Tolvaptan showed benefits in reducing body weight, increasing urine volume, and increasing serum sodium. No reduction in mortality was detected. However, the subgroup of patients with hyponatraemia might have better mortality outcome with tolvaptan. Tolvaptan appeared to be safe, as it did not cause worsening of the renal function or hypotension.
In conclusion, a meta-analysis of the published literature suggests short term benefits of tolvaptan. However, the impact on mortality is in-conclusive.
Alskaf, E; Tridente, A; Al-Mohammad, A. (2016). Tolvaptan for Heart Failure, Systematic Review and Meta-Analysis of Trials . Journal of Cardiovascular Pharmacology. Published online 4th May
« Back