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Relative efficacy of spironolactone, eplerenone, and cAnRenone in patients with chronic heart failure (RESEARCH): a systematic review and network meta-analysis of randomized controlled trials

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 endpo...

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Main Authors: Frankenstein, Lutz (Author) , Seide, Svenja (Author) , Täger, Tobias (Author) , Jensen, Katrin (Author) , Fröhlich, Hanna (Author) , Clark, Andrew L. (Author) , Seiz, Mirjam (Author) , Katus, Hugo (Author) , Nee, Paul (Author) , Uhlmann, Lorenz (Author) , Naci, Huseyin (Author) , Atar, Dan (Author)
Format: Article (Journal)
Language:English
Published: [2020]
In: Heart failure reviews
Year: 2020, Volume: 25, Issue: 2, Pages: 161-171
ISSN:1573-7322
DOI:10.1007/s10741-019-09832-y
Online Access:Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1007/s10741-019-09832-y
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Author Notes: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
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Summary: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.
Item Description:Published online: 30 July 2019
Gesehen am 14.04.2020
Physical Description:Online Resource
ISSN:1573-7322
DOI:10.1007/s10741-019-09832-y

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