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April 26, 2017New England Journal of Medicine272 citationsOpen Access

Spironolactone Metabolites in TOPCAT — New Insights into Regional Variation

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SDSimon de DenusEOEileen O’MearaADAkshay S. Desai

Key Result

Spironolactone metabolite canrenone was undetectable in 30% of TOPCAT participants from Russia compared with only 3% from the United States and Canada.

Key Points

  • To assess the adherence to spironolactone by measuring canrenone levels in TOPCAT participants.
  • Measured canrenone levels in subgroup of TOPCAT participants assigned to spironolactone.
  • Compared undetectable levels between participants from Russia and the United States and Canada.
  • 30% of participants from Russia had undetectable canrenone levels compared to only 3% from the United States and Canada.

Structured PICO

Does adherence to spironolactone vary by geographic region among participants in the TOPCAT trial?

P
Population
Subgroup of TOPCAT participants assigned to spironolactone
I
Intervention
Spironolactone
O
Outcome
Adherence assessed by spironolactone metabolite canrenone levelssurrogate

There was significant regional variation in adherence to spironolactone in the TOPCAT trial, with substantially higher rates of non-adherence in Russia compared to North America, which may explain the trial's regional outcome differences.

Abstract

In a subgroup of TOPCAT participants assigned to spironolactone, the spironolactone metabolite canrenone was measured to assess adherence. Canrenone levels were undetectable in 30% of participants from Russia, as compared with only 3% from the United States and Canada.

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Cite This Study

Denus et al. (2017) studied this question. Spironolactone metabolite canrenone was undetectable in 30% of TOPCAT participants from Russia compared with only 3% from the United States and Canada.

synapsesocial.com/papers/6a5ac49e6c03cbea17d303ddhttps://doi.org/10.1056/nejmc1612601
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Also Consider

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  1. 1Clinical Pharmacology of Spironolactone2022 · 2 citations
  2. 2CANRENONE—THE PRINCIPAL ACTIVE METABOLITE OF SPIRONOLACTONE?1976 · 28 citations
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  5. 5Spironolactone Metabolite Concentrations in Decompensated Heart Failure: Insights from the ATHENA-HF Trial2020 · 31 citations