What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Heart failure (n=21930). Intervention: Eplerenone vs. Spironolactone. Primary outcome: All-cause mortality (HR 0.78, 95% CI 0.64, 0.94, p=0.009).

September 13, 2024BMC Cardiovascular Disorders20 citationsOpen Access

Comparative effectiveness and safety of eplerenone and spironolactone in patients with heart failure: a systematic review and meta-analysis

AEAhmed ElshahatAl-Azhar University AMAhmed M. MansourAcademy of Medicine MEMohamed A. EllabbanLinköping University

Key Result

Eplerenone significantly reduced the risk of all-cause mortality by 22% (HR 0.78) compared to spironolactone in patients with heart failure.

Study Design

Type

Meta-Analysis (n=21,930)

Multicenter

Yes

Structured PICO

Does eplerenone reduce all-cause mortality in patients with heart failure compared to spironolactone?

Population

21,930 patients with heart failure, mean age 58.1 years, followed for a mean of 20 months across 10 studies comparing eplerenone and spironolactone.

Intervention

Eplerenone

Comparator

Spironolactone

Outcome

All-cause mortalityhard clinical

Eplerenone is associated with significantly lower all-cause mortality, cardiovascular mortality, and fewer adverse events like gynecomastia compared to spironolactone in patients with heart failure.

Main Result

Hazard Ratio: 0.78 (95% CI 0.64–0.94)

p-value: p=0.009

Limitations

Observational nature of many included studies could introduce potential selection bias.
Inclusion of RCTs and observational studies in a combined analysis can potentially induce inconsistency.
Insufficient number of studies to evaluate publication bias.

Abstract

BACKGROUND: Eplerenone and spironolactone, recognized as mineralocorticoid receptor antagonists (MRAs), have been reported to improve clinical prognosis among individuals diagnosed with heart failure (HF). However, the difference in the clinical effects between eplerenone and spironolactone in individuals with HF remains uncertain. We aimed to assess the impact of eplerenone compared to spironolactone on clinical outcomes within the HF population. METHODS: An extensive search was executed in several databases (PubMed, Web of Science, Scopus, Cochrane Library). All relevant studies evaluating eplerenone compared to spironolactone in patients with HF were included. Dichotomous data were pooled as Hazard ratio (HR) or Risk ratio (RR) with a 95% confidence interval (CI). Our main outcome was all-cause mortality. Secondary outcomes included death from cardiovascular causes, treatment withdrawal, and gynecomastia. RESULTS: Ten studies, comprising 21,930 HF individuals, were included in our investigation. Eplerenone showed a lower risk of all-cause mortality (HR = 0.78, 95%CI 0.64 to 0.94, P = 0.009) and cardiovascular mortality (HR = 0.54, 95%CI 0.39, 0.74, P = 0.0001) compared to spironolactone. Furthermore, eplerenone exhibited a reduced risk of treatment withdrawal (RR = 0.69, 95% CI 0.62, 0.78, P = 0.0001) and gynecomastia (RR = 0.07, 95% CI 0.02 to 0.31, P = 0.0001) than spironolactone. CONCLUSION: Eplerenone revealed lower all-cause and cardiovascular mortality events in comparison to spironolactone. Moreover, eplerenone was associated with lower gynecomastia and treatment withdrawal events compared to spironolactone. Further well-designed randomized controlled trials are still warranted better to identify the clinical differences between eplerenone and spironolactone. TRIAL REGISTRATION: Protocol registration: https://doi.org/10.17605/OSF.IO/VNMGK.

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