Comparative Effectiveness and Safety of Intermittent, Repeated, or Continuous Use of Levosimendan, Milrinone, or Dobutamine in Patients With Advanced Heart Failure: A Network and Single-Arm Meta-analysis

Abstract

To synthesize the available evidence regarding differences in the long-term safety and efficacy of intermittent, repeated, or continuous palliative inotropic therapy among patients with advanced heart failure (HF). We systematically searched the PubMed, Embase, and Cochrane Library electronic databases, with a cutoff date of November 23, 2023, for studies reporting outcomes in adult patients with advanced HF treated with intermittent, repeated, or continuous levosimendan, milrinone, or dobutamine. Forty-one studies (18 randomized controlled trials and 23 cohort studies) comprising 5137 patients met the inclusion criteria. The results of the network meta-analysis of randomized controlled trials showed that levosimendan had significant advantages over milrinone or dobutamine in reducing mortality and improving LVEF. A single-arm meta-analysis also indicated that levosimendan had the lowest mortality and significantly improved BNP and LVEF. Regarding safety, hypotension events were observed more frequently in the levosimendan group and milrinone groups. However, the current evidence is limited by the heterogeneity and relatively small sample size of the studies.

Repetitive Treatments With Inotropes in Advanced Heart Failure

“…In this context, I read with interest the article by Zhang X et al 4 “Comparative effectiveness and safety of intermittent or repeated use of levosimendan, milrinone, or dobutamine in patients with advanced heart failure: a network meta-analysis” published in this issue of J Cardiovasc Pharmacol. I commend the authors for their contribution in a field characterized by the absence of large clinical studies: Meta-analyses of the existing evidence can ignite the spark for further research.…”