Tolvaptan add-on therapy significantly alleviated dyspnea at 24 hours (RR 1.16; 95% CI 1.04-1.29) and reduced edema, but showed no significant benefits in mortality or rehospitalization.
Meta-Analysis (n=10,039)
Does tolvaptan added to conventional diuretic therapy improve clinical and safety outcomes in patients with acute heart failure?
Tolvaptan add-on therapy in acute heart failure improves short-term congestive symptoms and hyponatremia without increasing worsening renal function, but does not improve long-term mortality or rehospitalization.
Effect estimate: RR 1.16 (95% CI 1.04, 1.29)
Background: Several conflicting reviews have concluded that the use of loop diuretics is associated with poorer clinical and safety outcomes. Therefore, this study aimed to investigate the efficacy and safety of tolvaptan as an adjunct to conventional diuretic therapy in patients with acute heart failure (AHF). Methods: A comprehensive search was conducted on PubMed, Embase, ProQuest, EBSCO, and Cochrane Library until 24 May 2023 to identify randomized controlled trials that compared the effects of tolvaptan with conventional therapy and placebo in patients with AHF. The quality assessment of the included trials was conducted using the Cochrane risk of bias. A network meta-analysis (NMA) was conducted to examine the dosage effect of tolvaptan. Result: A total of 17 studies with 18 reports, involving 10,039 patients, were selected. The tolvaptan add-on therapy significantly alleviated dyspnea 24 h: RR 1.16 (1.04, 1.29), 48 h: RR 1.18 (1.04, 1.33), reduced body weight within 48 h Asian group, MD -0.93 (-1.48, -0.38); non-Asian group, MD -2.76 (-2.88, -2.65), reduced edema RR 1.08 (1.02, 1.15), increased serum sodium non-Asian group, MD 3.40 (3.02, 3.78), and resulted in a change in serum creatinine MD -0.10 (-0.18, -0.01). No significant differences were observed in mortality and rehospitalization. The NMA suggested that an intermediate dosage (15 mg/day) might offer the best efficacy in reducing dyspnea within 24 h, reducing edema, increasing serum sodium, and lowering the incidence of worsening renal function (WRF). Conclusion: In conclusion, the meta-analysis showed that tolvaptan contributed to the short-term alleviation of congestive symptoms, elevated sodium levels, and a lower incidence of WRF. However, no significant benefits were observed in long-term symptoms, rehospitalization rates, and mortality. An intermediate dosage of tolvaptan might be considered the optimal choice for various clinical outcomes. Systematic Review Registration: https://www.crd.york.ac.uk/, PROSPERO (CRD42023420288).
Pratama et al. (Thu,) conducted a meta-analysis in acute heart failure (AHF) (n=10,039). tolvaptan vs. conventional therapy and placebo was evaluated on dyspnea alleviation at 24 h (RR 1.16, 95% CI 1.04, 1.29). Tolvaptan add-on therapy significantly alleviated dyspnea at 24 hours (RR 1.16; 95% CI 1.04-1.29) and reduced edema, but showed no significant benefits in mortality or rehospitalization.