Tolvaptan in reversing worsening acute heart failure: A systematic review and meta-analysis

Abstract

ObjectiveIn this meta-analysis, we aimed to compare efficacy and clinical outcomes of tolvaptan in treating acute heart failure (AHF).MethodsUsing MEDLINE, we searched relevant clinical studies using tolvaptan that investigated clinical effects in treating AHF. We performed meta-analysis for potentially extractable clinical outcomes such as body weight reduction, change in serum sodium levels, and clinical or safety events including worsening heart failure, worsening renal function (WRF), all-cause mortality, rehospitalization, and dyspnea improvement.ResultsThe results showed that tolvaptan significantly reduced body weight (mean change: −1.28 kg, 95% credible interval (CI): −1.58–0.98), increased serum sodium levels (mean change: 3.48 mmol/L; 95% Cl: 3.22–3.74), and improved dyspnea function (odds ratio (OR): 1.43; 95% CI: 1.26–1.62) versus conventional therapy. The event risk of WRF was also significantly reduced (OR: 0.35; 95% CI: 0.15–0.80). Low, intermediate, and high tolvaptan doses did not reduce mortality and rehospitalization risks. No significant publication bias was observed regarding effects on mortality and rehospitalization.ConclusionCurrent evidence indicates that using tolvaptan as add-on therapy can decrease body weight, increase sodium levels, improve dyspnea function, and reverse WRF, which may circumvent loop diuretics overdose and improve outcomes in patients with AHF.

Tolvaptan add-on therapy and its effects on efficacy parameters and outcomes in patients hospitalized with heart failure

“… 8 , 9 , 10 , 11 We found no significant difference in change in creatinine between the two groups. Our results in conjunction with a recent meta-analysis by Wang, et al which concluded that add-on tolvaptan significantly reduced the risk of worsening renal failure 6 suggests that tolvaptan has no significant detrimental effect on renal function. Further, tolvaptan can be used in patients with creatinine clearance of up to 10 ml/min.…”

“…Our findings are consistent with the previous meta-analysis studies. 6 , 7 Like the prior studies including the EVEREST trial, our study concluded that add-on tolvaptan therapy significantly increased serum sodium levels compared to the standard diuretic therapy. 8 , 9 , 10 , 11 We found no significant difference in change in creatinine between the two groups.…”

“…A recent meta-analysis by Wang et al compared short-term and long-term efficacy of tolvaptan in acute HF with standard HF care, which demonstrated tolvaptan as add-on therapy can help reduce body weight, increase serum sodium concentration and helps improving dyspnea score. 6 However, this study included randomized clinical trials and observational studies as well as combined studies with short term (up to 48 h), medium term (up to 7 days) and long term (up to 18 months) follow up while analyzing clinical outcomes. We performed an updated meta-analysis of randomized double-blinded trials comparing add on tolvaptan compared with standard diuretic therapy in patients hospitalized with acute HF and provided the outcomes on short term, medium term, and long-term follow-ups.…”

Advanced heart failure

“…У пациентов с нормальным или повышенным системным артериальным давлением эффективной может быть комбинация диуретиков с вазодилататорами, из которых наиболее перспективным выглядит применение серелаксина (рекомбинантный аналог человеческого релаксина-2), низких доз несиритида (рекомбинантный человеческий мозговой наутрийуретический пептид) и антагониста вазопрессина толваптана (особенно при гипонатриемии разведения) [63,65,66]. Наконец, сдвинуть процесс с мертвой точки и достигнуть заветной эуволемии при рефрактерном отечном синдроме может помочь применение в составе комбинированной терапии препаратов из группы ингибиторов натрийзависимого котранспортера глюкозы 2-го типа (например, дапаглифлозина или эмпаглифлозина) [63,67,68].…”

Cost-Effectiveness of long-term tolvaptan administration for chronic heart failure treatment in Japan

“…While the effectiveness of TLV for ADHF treatment has been well established, long-term TLV administration for CHF treatment remains controversial. Although several recent studies have demonstrated the usefulness of TLV in patients with CHF, most of them had a small sample size and were observational studies [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] . Furthermore, the cost of TLV is much higher than that of other conventional drugs for HF treatment; however, no study has investigated the cost-effectiveness of long-term TLV administration for CHF treatment in Japan.…”