Key result
Tolvaptan 30 mg matches higher doses, increasing CHF urine output by ~2 L versus placebo.
Why the study?
The optimal dosage of oral tolvaptan for efficacy and safety in patients with congestive heart failure remains unclear.
Does oral tolvaptan at different dosages improve urine output, body weight, and serum sodium in patients with congestive heart failure?
Meta-Analysis (n=5,793)
Does oral tolvaptan at different dosages improve urine output, body weight, and serum sodium in patients with congestive heart failure?
Mean Difference: 2.03 (95% CI 1.3–2.71)
Tolvaptan 30 mg and 45 mg appear to be the optimal dosages for improving fluid balance and serum sodium in congestive heart failure without significantly increasing adverse effects, though it does not reduce all-cause mortality.
Tolvaptan 30–45 mg balances efficacy and safety in CHF; extends RCT data by ranking dosages in network meta-analysis.
AIMS: Several studies reported treatment benefits of tolvaptan in patients with congestive heart failure (CHF). However, the optimal dosage remains unclear. We aimed to compare different dosage of tolvaptan to determine the optimal dosage in terms of the efficacy and safety. METHODS: We searched MEDLINE, PubMed, EMBASE, Cochrane CENTRAL and ClinicalTrials.gov through Aug 31, 2016. Randomized controlled trials (RCTs) comparing tolvaptan of different dosages or to placebo in patients with CHF were included. We used network meta-analysis to look for the optimal dosage in terms of effectiveness and safety. Urine output, body weight change and change in serum sodium were the main outcomes of efficacy. Adverse effects were the secondary outcomes. Quality was assessed by Cochrane risk-of-bias tool. RESULTS: Twelve RCTs reporting 14 articles with 5793 patients (mean age, 65.7 ± 11.9 years; 73.7% man) were included. Compared with placebo, the tolvaptan 30 mg had similar effects to tolvaptan 45-90 mg in terms of urine output (mean difference [MD] 2.03 liter; 95% confidence interval [CI] 1.3 to 2.71), body weight change (MD -1.12 kg; 95% CI -1.37 to -0.88) and change in serum sodium (MD 3.06 meq/L; 95% CI 2.43 to 3.68). Compared with placebo, tolvaptan of different dosage showed a non-significant higher risk of adverse effects. CONCLUSIONS: These findings suggest that tolvaptan 30 mg and 45 mg may be the optimum dosage for CHF patients, because of its ability to provide favourable clinical results without greater adverse effects. However, tolvaptan is not beneficial for reducing all-cause mortality in CHF patients.
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Wu et al. (2017) conducted a meta-analysis in Congestive heart failure (CHF) (n=5,793). Tolvaptan vs. Placebo was evaluated on Urine output (MD 2.03, 95% CI 1.3-2.71). Tolvaptan 30 mg had similar effects to 45-90 mg, significantly increasing urine output (MD 2.03 L) and serum sodium (MD 3.06 meq/L) compared to placebo in patients with congestive heart failure.
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