Renal function stratified dose comparisons of eplerenone versus placebo in the EMPHASIS-HF trial

• Tipo: Artigo em Revista Científica Internacional
• Data: 2019

Autores

Ferreira, JP (Autor) FMUP; Abreu, P (Autor) Outra; McMurray, JJV (Autor) Outra; van Veldhuisen, DJ (Autor) Outra; Swedberg, K (Autor) Outra; Pocock, SJ (Autor) Outra; Vincent, J (Autor) Outra; Lins, K (Autor) Outra; Rossignol, P (Autor) Outra; Pitt, B (Autor) Outra; Zannad, F (Autor) Outra

Revista

Título: European Journal of Heart Failure

Vol. 21

Páginas: 345-351

ISSN: 1388-9842

Editora: Wiley-Blackwell

Indexação

ISI Web of Knowledge - 23 Citações

Scopus - 25 Citações

Outras Informações

ID Authenticus: P-00Q-8H8

DOI: 10.1002/ejhf.1400

Abstract (EN): Background Current heart failure guidelines recommend target eplerenone dose of 50 mg/day. We have examined the effect of different eplerenone doses based on pre-specified renal function stratification in the Eplerenone in Mild Patients Hospitalization and Survival Study in Heart Failure (EMPHASIS-HF). Methods and results In EMPHASIS-HF, the target dose of eplerenone/placebo was stratified at randomization according to estimated glomerular filtration rate (eGFR): 50 mg/day if eGFR >= 50 mL/min/1.73m(2) and <= 25 mg/day if eGFR 30-49mL/min/1.73m(2). Patients remained within these dose ranges during the trial (as per stratification). The primary outcome was a composite of heart failure hospitalization or cardiovascular mortality. Eplerenone was superior to placebo within each respective eGFR stratum [eplerenone vs. placebo in the eGFR >= 50 mL/min/1.73m2 stratum: hazard ratio (HR) 0.58, 95% confidence interval (CI) 0.45-0.74; and eplerenone vs. placebo in the eGFR 30-49mL/min/1.73m(2) stratum: HR 0.62, 95% CI 0.49-0.78; P-interaction = 0.89]. Despite receiving lower eplerenone doses, patients in the eGFR 30-49mL/min/1.73m(2) stratum more often had hyperkalaemia, renal failure events, and drug discontinuation. Conclusion In EMPHASIS-HF the eplerenone dose was stratified according to renal function and the treatment effect was not influenced by renal function: 25 mg/day in patients with eGFR 30-49mL/min/1.73m(2) was as effective as 50 mg/day in patients with eGFR> = 50 mL/min/1.73m(2). However, patients with impaired renal function experienced more adverse events, despite reveiving lower eplerenone doses. Current guidelines do not recommend tailoring the dose of eplereone according to renal function but the current data suggest they should.

Idioma: Inglês

Tipo (Avaliação Docente): Científica

Nº de páginas: 7