Key result
Spironolactone metabolite canrenone was undetectable in 30% of TOPCAT participants from Russia compared with only 3% from the United States and Canada.
Why the study?
Does adherence to spironolactone vary by geographic region among participants in the TOPCAT trial?
Does adherence to spironolactone vary by geographic region among participants in the TOPCAT trial?
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.
Answers are grounded in this paper and cite their sources.
Questions the reliability of TOPCAT results from Russia due to likely nonadherence; leaves open spironolactone's benefit in HFpEF populations with poor adherence.
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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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.
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