Efficacy and Safety of Dronedarone in Patients Previously Treated With Other Antiarrhythmic Agents

Abstract

Background: Currently available antiarrhythmic drugs (AADs) for the prevention of atrial fibrillation (AF)/atrial flutter (AFL) suffer from incomplete efficacy and poor tolerability. In patients previously treated with a class Ic agent, dronedarone decreased the risk of recurrence by 31.4% (HR: 0.69; 95% CI: 0.53-0.89; P = 0.004), whereas in patients previously treated with sotalol, dronedarone showed a trend toward a decrease of risk of recurrence (HR: 0.86; 95% CI: 0.67-1.11; P = 0.244). Dronedarone was equally effective irrespective of whether class Ic or sotalol were stopped for lack of efficacy or adverse events (AEs). Discontinuation rates were similar in the 2 groups (55.9% vs 43.1%), as were incidence of AEs and serious AEs. Conclusions: Dronedarone seems to be effective in preventing AF recurrences in patients without permanent AF previously treated with other AADs, even if those were discontinued for lack of efficacy. Dronedarone appears to be well tolerated even in patients who already had tolerability issues with AADs.

Impact of dronedarone on the risk of myocardial infarction and stroke in atrial fibrillation patients followed in general practices in Germany

“…There are major differences in patient characteristics between clinical trials [6,18,[29][30][31] and real-world analyses [19,32], as clinical trials are designed to evaluate the efficacy and safety of a drug under ideal conditions. For example, clinical trials have specific inclusion or exclusion criteria, and ensure that patients have continuous follow-up and good compliance.…”

Evaluation of the efficacy and safety of different class III anti-arrhythmic drugs for treating patients with atrial fibrillation: a network meta-analysis

“…Dronedarone has a similar chemical structure to amiodarone and is thus referred to as a secondgeneration amiodarone. Further research conducted by Guerra et al, confirmed that dronedarone is the most effective AAD for treating AF and is even tolerated by patients who previously presented with an inability to tolerate other AADs [29]. According to Ezekowitz et al, dronedarone can prevent the occurrence of AF [30].However, there are studies that indicate that dronedarone treatment in patients with AF is less effective compared to amiodarone [36,37].…”

“…We read the full-text and abstracts of the remaining 186 studies, and identified 31 eligible articles . Among these, 24 were in Chinese and the remaining 7 were in English [28][29][30][31][32][33][34] (Fig. 1).…”

“…The literature refers to paroxysmal, persistent, and permanent AF, as reported in the references provided here: paroxyxmal AF [4,7,9,10,13,14,18,20,22,24,31,32], persistent AF [5-7, 15, 16, 22, 25, 26, 28], and permanent AF [7]. Duration of AF was explained in [4, 6, 8, 14-16, 18, 22, 23, 26-30, 32-34], and was referred to as AF pathogeny as follows: valvular heart disease [5,8,10,12,17,20,22,23,26,29,34], hypertensive heart disease [10,12,20,22,25,26,28,30,[32][33][34], coronary heart disease [10,12,20,22,25,26,[28][29][30][32][33][34], and dilated cardi...…”

“…Duration of AF was explained in [4, 6, 8, 14-16, 18, 22, 23, 26-30, 32-34], and was referred to as AF pathogeny as follows: valvular heart disease [5,8,10,12,17,20,22,23,26,29,34], hypertensive heart disease [10,12,20,22,25,26,28,30,[32][33][34], coronary heart disease [10,12,20,22,25,26,[28][29][30][32][33][34], and dilated cardiomyopathy [12,28]. The general quality grade of the studies was B [28][29][30][31][32]; in a few exceptions the grade was C [4-27, 33, 34] (Table.1).…”