Oral Metolazone Versus Intravenous Chlorothiazide as an Adjunct to Loop Diuretics for Diuresis in Acute Decompensated Heart Failure With Reduced Ejection Fraction

Bohn, Brian C; Hadgu, Rim M.; Pope, Hannah; Shuster, Jerrica E.

doi:10.1177/0018578718795855

Cited by 3 publications

(9 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Data evaluating the efficacy and safety of oral metolazone compared to parenteral chlorothiazide are primarily limited to single center, retrospective cohort studies conducted between 2015 and 2019, with only one prospective, randomized trial. [10][11][12][13] Table 1 summarizes study design, duration, treatment arms, baseline characteristics, and efficacy/safety outcomes of individual studies. Table 2 summarizes the results of the GRACE checklist.…”

Section: Resultsmentioning

confidence: 99%

“…10,11 While the two prior studies included a mix of HFpEF and HFrEF patients with ADHF, in a recent study, the investigators analyzed 168 Study D1 D2 D3 D4 D5 D6 M1 M2 M3 M4 M5 2015 10 Y Y Y Y Y Y N Y N Y N R 2016 11 Y Y Y Y Y Y Y Y Y Y Y a 2019 12 Y Y Y Y Y N Y Y N Y N R 2019 patients admitted with ADHF but limited the cohort to patients with HFrEF (LVEF 40% or less). 12 This is the only study to date that examined patients with HFrEF exclusively. All patients received IV loop diuretic at least 24 hours prior to receiving at least one dose of metolazone or chlorothiazide at doses of at least 5 or 500 mg, respectively.…”

Section: Resultsmentioning

confidence: 99%

“…The authors concluded that metolazone and chlorothiazide increase UOP to a similar degree when utilized as an adjunct to loop diuretics in patients with ADHF and HFrEF. 12 In the most recent study, researchers analyzed 60 patients admitted with ADHF and treated with either PO metolazone, IV chlorothiazide, or PO tolvaptan. 13 To date, this is the only prospective, randomized trial of its nature.…”

Section: Resultsmentioning

confidence: 99%

“…Until recently, there was a lack of head-to-head comparisons to support the use of one agent over the other; however, studies published in the last 5 years have sought to end this debate. [10][11][12][13] All studies demonstrated increased net UOP with both agents and found either no difference or non-inferiority of oral metolazone compared to IV chlorothiazide. [10][11][12][13] Combined, these data have demonstrated that both agents augment diuresis to a similar degree in ADHF patients with high-dose loop diuretic resistance with comparable safety profiles.…”

Section: Discussionmentioning

confidence: 97%

“…11,13 Additionally, pooling and analyzing the combined results further minimizes this possibility. Several studies had significant variations in baseline loop diuretics, with chlorothiazide groups having higher IV furosemide equivalents in studies [10][11][12] and more continuous infusion loop diuretics in the Bohn study. Though metolazone was shown to have similar efficacy despite less aggressive loop diuretic use than in the chlorothiazide groups of these studies, it may be perceived that patients in the chlorothiazide groups had a greater degree of loop diuretic resistance.…”

Section: Discussionmentioning

confidence: 99%

See 4 more Smart Citations

A Systematic Review and Meta‐Analysis of Metolazone Compared to Chlorothiazide for Treatment of Acute Decompensated Heart Failure

2020

View full text Add to dashboard Cite

Treatment of volume overload in the setting of acute decompensated heart failure (ADHF) is typically achieved through the use of loop diuretics. While they are highly effective, some patients may develop loop diuretic resistance. One strategy to overcome this scenario includes sequential nephron blockade with a thiazide‐type diuretic; however, it is unknown which thiazide‐type diuretic used in this setting is most effective. A systematic review and meta‐analysis were performed to compare the efficacy and safety of chlorothiazide with metolazone as add‐on therapy in the setting of loop diuretic resistance for the treatment of ADHF. Literature searches were conducted through PubMed, Google Scholar, and Science Direct from inception through February 2020 using the following search terms alone or in combination: metolazone, chlorothiazide, acute decompensated heart failure, loop diuretic, and urine output. All English‐language prospective and retrospective trials and abstracts comparing metolazone to chlorothiazide for the treatment of ADHF were evaluated. Studies were included if they analyzed urine output for at least 24 hours in patients with ADHF. Meta‐analysis was conducted to evaluate pooled effect size by using a random‐effect model. Primary outcomes included net and total urine output. Secondary outcomes included commonly reported safety outcomes. Four studies comparing the use of metolazone to chlorothiazide as an adjunct to loop diuretics to treat ADHF were included in the evaluation. Metolazone was as effective as chlorothiazide to augment loop diuretic therapy in ADHF in most studies with no pooled difference in net or total urine output. However, there were notable differences in baseline loop diuretic dosing, ejection fraction, renal function, race, and endpoint timing across studies. Adverse effects were commonly observed and included electrolyte abnormalities, change in renal function, and hypotension but were comparable between groups. Metolazone is as effective as chlorothiazide as add‐on to loop diuretics in treating ADHF without an increase in safety concerns.

show abstract

Section: Resultsmentioning

confidence: 99%