Key result
Torasemide 20 mg significantly differed from furosemide 40 mg in increasing urine volume (SDM -0.78; 95% CI -1.52 to -0.053; P=0.036), with potential benefits in hospital stay and ejection fraction.
Why the study?
Diuretics are central to heart failure treatment, and torasemide has potential advantages over other loop diuretics, prompting a meta-analysis comparing torasemide with furosemide.
Does torasemide improve clinical and surrogate outcomes compared to furosemide in patients with heart failure?
Meta-Analysis (n=1,598)
Does torasemide improve clinical and surrogate outcomes compared to furosemide in patients with heart failure?
Standardized Mean Difference: -0.78 (95% CI -1.52–-0.053)
p-value: p=.036
Torasemide may offer advantages over furosemide in heart failure management, including increased urine volume, reduced hospital stay, and improved ejection fraction, though no significant difference in mortality was observed.
Torasemide may shorten stays and improve EF versus furosemide in HF; extends RCT evidence without mortality benefit.
AIM: Diuretics are a cornerstone in treatment of heart failure (HF). Torasemide is a loop diuretic with a potential advantage over other diuretics. We aim to meta-analyse and compare the effect of torasemide with furosemide in HF patients. METHODS: A comprehensive literature search using 12 databases including PubMed, Scopus, and Web of Science was performed. All randomized controlled trials (RCTs) comparing furosemide and torasemide in HF patients were included and meta-analysed. We assessed the risk of bias using Cochrane Collaboration's tool. The protocol was registered in PROSPERO (CRD42016046112). RESULTS: Eighteen RCTs with 1598 patients were included. There was a significant difference between torasemide 20 mg and furosemide 40 mg in increasing the urine volume (standard difference of the mean (SDM) [95% confidence interval] = -0.78 [-1.52 to -0.053], P = .036). Torasemide 10 mg and 10 to 20 mg have a significant effect on potassium excretion in comparison with furosemide 25 to 40 mg (P = .018 and .023, respectively). In general, torasemide and furosemide have no significant difference in mortality, edema improvement, weight loss, heart rate, and reducing systolic/diastolic blood pressure. However, oral torasemide has a significant lower hospital stay P < .001 and superior effect in improving ejection fraction P = .029. CONCLUSION: Although not all results are statistically significant, torasemide has potential advantages on multiple aspects of HF management when compared with furosemide. More studies are needed to clarify these effects.
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Sherif et al. (2019) conducted a meta-analysis in heart failure (n=1,598). Torasemide vs. Furosemide was evaluated on urine volume (SDM -0.78, 95% CI -1.52 to -0.053, p=.036). Torasemide 20 mg significantly differed from furosemide 40 mg in increasing urine volume (SDM -0.78; 95% CI -1.52 to -0.053; P=0.036), with potential benefits in hospital stay and ejection fraction.
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