Efficacy of torsemide versus furosemide in heart failure: a systematic review and meta-analysis of randomized controlled trials

Introduction Loop diuretics are a cornerstone in the symptomatic management of heart failure. There is conflicting evidence regarding potential differences between torsemide and furosemide in their effects on heart failure outcomes. Therefore, we conducted a meta-analysis of randomized controlled trials (RCTs) to compare the therapeutic efficacy of furosemide versus torsemide in the management of heart failure. Methods Medline/PubMed, Embase, and Cochrane Central Register of Controlled Trials were queried for studies comparing furosemide to torsemide in heart failure from inception to January 2023. Outcomes of interest included all-cause mortality, hospitalization due to heart failure, and weight change. Results Our analysis included 10 RCTs comprising 4011 patients, of whom 2019 were treated with furosemide and 1992 patients were treated with torsemide. There was no significant difference between the groups in terms of all-cause mortality (OR = 0.99; 95% CI: 0.97–1.02; p = 0.66; I2 = 0.03%) or heart failure hospitalization (OR = 0.96; 95% CI: 0.87–1.06; p = 0.38; I2 = 89%). Both diuretics had a significant effect on weight change: torsemide (mean difference 2.36; 95% CI: 0.5–4.22; p = 0.01; I2 = 0.0%) and furosemide (mean difference 2.48; 95% CI: 0.81–4.15; p = 0.00; I2 = 0.0%). There was no significant difference in weight change between the two diuretics (mean difference –0.15; 95% CI: –0.82–0.52; p = 0.66; I2 = 94%). Conclusions Furosemide and torsemide have similar impacts on mortality, hospitalization due to heart failure, and weight change in patients with congestive heart failure.