Effects of Tolvaptan in patients with acute heart failure: a systematic review and meta-analysis

Abstract

BackgroundAcute heart failure, which requires urgent evaluation and treatment, is a leading cause for admission to the emergency department. The aim of this meta-analysis was to evaluate the effects of tolvaptan on acute heart failure and compare them with the effects of conventional therapy or placebo.MethodsThe electronic databases PubMed, EMBASE, and the Cochrane Controlled Trial registry were searched from their starting dates to October 24, 2016. Two authors independently read the trials and extracted related information from the included studies. We used fixed-effects or random-effects models to assess the overall combined risk estimates according to I2 statistics. Analysis to determine sensitivity and publication bias was conducted.ResultsSix randomised controlled trials from eight articles, with a total of 746 patients, were included for analysis. Compared with the control, tolvaptan reduced body weight in two days (WMD 1.35; 95% CI 0.75 to 1.96), elevated sodium level in two days (WMD 2.33; 95% CI 1.08 to 3.57) and five days (WMD 1.57; 95% CI 0.04 to 3.09), and ameliorated symptoms of dyspnoea (RR 0.82; 95% CI 0.71–0.95). However, tolvaptan did not improve long-term (RR 1.04; 95% CI 0.66–1.62) or short-term all-cause mortality (RR 0.89; 95% CI 0.45–1.76), incidence of clinical events (worsening heart failure, RR 0.75; 95% CI 0.50–1.12 and worsening renal function, RR 0.97; 95% CI 0.75–1.27), and length of hospital stay in patients (WMD 0.14; 95% CI -0.29 to 2.38) with acute heart failure.ConclusionTolvaptan can decrease body weight, increase serum sodium level, and ameliorate some of the congestion symptoms in patients with acute heart failure, which may help avoid the overdose of loop diuretics, especially in patients with renal dysfunction.Electronic supplementary materialThe online version of this article (doi:10.1186/s12872-017-0598-y) contains supplementary material, which is available to authorized users.

Real-World Effectiveness and Tolerability of Tolvaptan in Patients With Heart Failure ― Final Results of the Samsca Post-Marketing Surveillance in Heart Failure (SMILE) Study ―

“…Consistent with our findings, a meta-analysis of tolvaptan studies in patients with acute HF (6 randomized controlled trials in 746 patients) reported improvements compared with control (placebo or conventional therapy) in body weight, serum sodium concentration and congestive symptoms, but without effect on short-term (≤30 days) or long-term (>30 days) all-cause death. 26 Our subgroup analyses showed that certain disease/patient factors affect the risk of death. Specifically, hyponatremia severity at baseline, the extent of tolvaptan-induced improvement in hyponatremia, and patients' ability to respond to tolvaptan with increased urine output are associated with lower 6-month all-cause death.…”

Tolvaptan Response Improves Overall Survival in Patients with Refractory Ascites: A Meta-Analysis

“…It exerts its action by inhibiting water reabsorption, leading to aquaresis without affecting electrolyte excretion [7]. The main clinical indication of tolvaptan is the correction of euvolemic and hypervolemic hyponatremia [8], although growing evidence also suggests its efficacy in the management of fluid retention in the setting of acute heart failure [9] and cardiac surgery [10], since it is able to improve congestive symptoms without compromising renal function.…”

Effects of Tolvaptan on Volume Overload in Patients with Heart Failure

“…Since 2015, meta-analyses of tolvaptan have been reported. [10][11][12][13][14] In recent years, several randomized controlled trials (RCTs) performed in actual clinical settings in Japan have also been reported, calling attention to the need for integrated analysis of differences between the doses of tolvaptan used in previous clinical studies in Europe and North America and the doses currently used in Japan. We performed a meta-analysis of RCTs in Europe, North America, and Japan.…”