Dronedarone was less effective than amiodarone in preventing AF recurrence or premature study discontinuation (75.1% vs 58.8%; HR 1.59; 95% CI 1.28-1.98; P<0.0001).
RCT (n=504)
Double-blind
randomized
Does dronedarone reduce recurrence of AF or premature study discontinuation compared to amiodarone in amiodarone-naïve patients with persistent atrial fibrillation?
In patients with persistent AF, dronedarone is less effective than amiodarone for maintaining sinus rhythm but offers a better safety profile.
Effect estimate: HR 1.59 (95% CI 1.28-1.98)
Absolute Event Rate: 75.1% vs 58.8%
p-value: p=< 0.0001
INTRODUCTION: We compared the efficacy and safety of amiodarone and dronedarone in patients with persistent atrial fibrillation (AF). METHODS: Five hundred and four amiodarone-naïve patients were randomized to receive dronedarone 400 mg bid (n = 249) or amiodarone 600 mg qd for 28 days then 200 mg qd (n = 255) for at least 6 months. Primary composite endpoint was recurrence of AF (including unsuccessful electrical cardioversion, no spontaneous conversion and no electrical cardioversion) or premature study discontinuation. Main safety endpoint (MSE) was occurrence of thyroid-, hepatic-, pulmonary-, neurologic-, skin-, eye-, or gastrointestinal-specific events, or premature study drug discontinuation following an adverse event. RESULTS: Median treatment duration was 7 months. The primary composite endpoint was 75.1 and 58.8% with dronedarone and amiodarone, respectively, at 12 months (hazard ratio HR 1.59; 95% confidence interval CI 1.28-1.98; P < 0.0001), mainly driven by AF recurrence with dronedarone compared with amiodarone (63.5 vs 42.0%). AF recurrence after successful cardioversion was 36.5 and 24.3% with dronedarone and amiodarone, respectively. Premature drug discontinuation tended to be less frequent with dronedarone (10.4 vs 13.3%). MSE was 39.3 and 44.5% with dronedarone and amiodarone, respectively, at 12 months (HR = 0.80; 95% CI 0.60-1.07; P = 0.129), and mainly driven by fewer thyroid, neurologic, skin, and ocular events in the dronedarone group. CONCLUSION: In this short-term study, dronedarone was less effective than amiodarone in decreasing AF recurrence, but had a better safety profile, specifically with regard to thyroid and neurologic events and a lack of interaction with oral anticoagulants.
Heuzey et al. (Wed,) conducted a rct in persistent atrial fibrillation (n=504). dronedarone vs. amiodarone 600 mg qd for 28 days then 200 mg qd was evaluated on recurrence of AF (including unsuccessful electrical cardioversion, no spontaneous conversion and no electrical cardioversion) or premature study discontinuation (HR 1.59, 95% CI 1.28-1.98, p=< 0.0001). Dronedarone was less effective than amiodarone in preventing AF recurrence or premature study discontinuation (75.1% vs 58.8%; HR 1.59; 95% CI 1.28-1.98; P<0.0001).