Amiodarone was superior to dronedarone for preventing recurrent atrial fibrillation (OR 0.49; 95% CI 0.37-0.63; p<0.001), but had more adverse events requiring drug discontinuation.
Meta-Analysis
Does dronedarone compared to amiodarone improve the prevention of recurrent atrial fibrillation in patients with atrial fibrillation?
Dronedarone is less effective than amiodarone for maintaining sinus rhythm in atrial fibrillation but is associated with fewer adverse effects and a trend toward lower mortality.
Effect estimate: OR 0.49 (95% CI 0.37 to 0.63)
p-value: p=< 0.001
OBJECTIVES: We sought to compare the efficacy and safety of dronedarone versus amiodarone for the prevention of recurrent atrial fibrillation (AF). BACKGROUND: Dronedarone is a noniodinated amiodarone congener developed to maintain sinus rhythm. Few data are available to directly compare the efficacy and safety of dronedarone versus amiodarone. METHODS: We conducted a systematic overview of all randomized controlled trials in which the authors evaluated dronedarone or amiodarone for the prevention of AF. The effect of amiodarone versus dronedarone was summarized by the use of indirect comparison meta-analysis and normal logistic meta-regression models. RESULTS: We identified 4 placebo-controlled trials of dronedarone, 4 placebo-controlled trials of amiodarone, and 1 trial of dronedarone versus amiodarone. By using random-effects modeling, we found that there was a significant estimated reduction in recurrent AF with amiodarone versus placebo (odds ratio OR: 0.12; 95% confidence interval CI: 0.08 to 0.19) but not dronedarone versus placebo (OR: 0.79; 95% CI: 0.33 to 1.87). A normal logistic regression model incorporating all trial evidence found amiodarone superior to dronedarone (OR: 0.49; 95% CI: 0.37 to 0.63; p < 0.001) for the prevention of recurrent AF. In contrast, these models also found a trend toward greater all-cause mortality (OR: 1.61; 95% CI: 0.97 to 2.68; p = 0.066) and greater overall adverse events requiring drug discontinuation with amiodarone versus dronedarone (OR: 1.81; 95% CI: 1.33 to 2.46; p < 0.001). CONCLUSIONS: Dronedarone is less effective than amiodarone for the maintenance of sinus rhythm, but has fewer adverse effects. For every 1,000 patients treated with dronedarone instead of amiodarone, we estimate approximately 228 more recurrences of AF in exchange for 9.6 fewer deaths and 62 fewer adverse events requiring discontinuation of drug.
“Dronedarone has, at best, modest effectiveness as an antiarrhythmic agent, and it has not been proven to be any safer than amiodarone. Amiodarone does have the potential for toxicity that can adversely impact quality of life, but it's also very effective and we can manage side effects or avoid them by lowering the dose. The argument that dronedarone is potentially safer than amiodarone is weakened by the fact that it's also half as effective. However, patient preference is an important consideration in treatment decisions. There are some patients who might consider improved short-term tolerability over reduced efficacy an acceptable tradeoff.”
Piccini et al. (Tue,) conducted a meta-analysis in atrial fibrillation. Dronedarone vs. Amiodarone was evaluated on recurrent atrial fibrillation (OR 0.49, 95% CI 0.37 to 0.63, p=< 0.001). Amiodarone was superior to dronedarone for preventing recurrent atrial fibrillation (OR 0.49; 95% CI 0.37-0.63; p<0.001), but had more adverse events requiring drug discontinuation.