Eplerenone is not superior to older and less expensive aldosterone antagonists
American Journal of Medicine, 08/16/2012
Chatterjee S et al. – Eplerenone does not appear to be more effective in reducing clinical events compared with older, less expensive aldosterone antagonists.Methods
- The authors searched the PubMed, CENTRAL, CINAHL, and EMBASE databases for randomized controlled trials from 1966 through July 2011.
- Interventions included aldosterone antagonists (Aldactone [Pfizer, NY, NY], canrenone, eplerenone) in systolic heart failure.
- The comparator included standard medical therapy or placebo, or both.
- Outcomes assessed were mortality in the intervention versus the comparator groups, and rates of adverse events at the end of at least 8 weeks of follow–up.
- Event rates were compared using a forest plot of relative risk (RR) (95% confidence interval [CI]) using a random–effects model (Mantel–Haenszel) between the aldosterone antagonists and controls.
- Authors included 13 studies for aldosterone antagonists other than eplerenone, and 3 studies for eplerenone.
- There was significant reduction of mortality with all aldosterone antagonists, but eplerenone (15% mortality relative reduction; RR 0.85; 95% CI, 0.77–0.93; P=.0007) was outperformed by other aldosterone antagonists, namely, spironolactone and canrenone (26% mortality relative reduction; RR 0.74; 95% CI, 0.66–0.83; P <.0001).
- Reduction in cardiovascular mortality with eplerenone was 17% (RR 0.83; 95% CI, 0.75–0.92; P=.0005), while that with other aldosterone antagonists was 25% (RR 0.75; 95% CI, 0.67–0.84, P <.0001), without contributing significantly to an improved side–effect profile.