Meta-Analysis Comparing Torsemide Versus Furosemide in Patients With Heart Failure

Although torsemide's oral bioavailability and half-life theoretically render it a more efficient diuretic than furosemide, the clinical outcomes of torsemide compared with furosemide remain unclear. We performed a systematic review and meta-analysis, including all published studies that compare...

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Bibliographic Details
Published in:The American journal of cardiology 2020-01, Vol.125 (1), p.92-99
Main Authors: Abraham, Bishoy, Megaly, Michael, Sous, Mina, Fransawyalkomos, Mina, Saad, Marwan, Fraser, Robert, Topf, Joel, Goldsmith, Steven, Simegn, Mengistu, Bart, Bradley, Azzo, Zain, Mesiha, Nancy, Sharma, Rajaninder
Format: Article
Language:English
Subjects:
Beta blockers
Bioavailability
Clinical trials
Confidence intervals
Congestive heart failure
Diuretics
Furosemide
Furosemide - therapeutic use
Heart failure
Heart Failure - drug therapy
Heart Failure - physiopathology
Humans
Laboratories
Meta-analysis
Mortality
Side effects
Sodium Potassium Chloride Symporter Inhibitors - therapeutic use
Statistical analysis
Stroke Volume - drug effects
Stroke Volume - physiology
Studies
Torsemide - therapeutic use
Treatment Outcome
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Summary:Although torsemide's oral bioavailability and half-life theoretically render it a more efficient diuretic than furosemide, the clinical outcomes of torsemide compared with furosemide remain unclear. We performed a systematic review and meta-analysis, including all published studies that compared torsemide and furosemide use in heart failure patients from January 1996 through August 2019. Nineteen studies (9 randomized control trials [RCTs] and 10 observational studies) with a total of 19,280 patients were included. During a mean follow-up duration of 15 months, torsemide was associated with a numerically lower risk of hospitalization due to heart failure (10.6% vs 18.4%; odds ratio [OR] 0.72, 95% confidence interval [CI] [0.51, 1.03], p = 0.07, I2 = 18%; number needed to treat [NNT] = 23) compared with furosemide. Torsemide was associated with statistically significant more improvement in functional status from New York Heart Association (NYHA) class III/IV to I/II (72.5% vs 58%; OR 2.32, 95% CI (1.32, 4.1), p = 0.004, I2 = 27%; NNT = 5) and lower risk of cardiac mortality (1.5% vs 4.4%; OR 0.37, 95% CI (0.20, 0.66), p
ISSN:0002-9149
1879-1913
DOI:10.1016/j.amjcard.2019.09.039