Short‐Term Efficacy and Safety of Torasemide and Furosemide in 366 Dogs with Degenerative Mitral Valve Disease: The TEST Study

Abstract

BackgroundFurosemide is the only loop diuretic recommended by the ACVIM consensus guidelines for treatment of congestive heart failure (CHF) in dogs related to degenerative mitral valve disease (DMVD). Torasemide is another potent loop diuretic with a longer half‐life and a higher bioavailability.Objectives(1) To demonstrate that torasemide given once a day (q24h) is noninferior to furosemide given twice a day (q12h) for treating dogs with CHF; (2) and to compare the effect of the 2 drugs on the time to reach a composite cardiac endpoint “spontaneous cardiac death, euthanasia due to heart failure or CHF class worsening.”AnimalsA total of 366 dogs with CHF attributable to DMVD.MethodsAnalysis of 2 prospective randomized single‐blinded reference‐controlled trials was performed. Dogs orally received either torasemide q24h (n = 180) or furosemide q12h (n = 186) in addition to standard CHF therapy over 3 months. The primary efficacy criterion was the percentage of dogs with treatment success assessed in each study. The time to reach the composite cardiac endpoint was used as secondary criterion in the overall population.ResultsTorasemide was noninferior to furosemide (P torasemide − P furosemide = +7%; 95% CI [−8%; +22%] and P torasemide − P furosemide = +1%; 95% CI [−12%; +14%], respectively, in Study 1 and Study 2). Torasemide (median dose = 0.24 mg/kg/d q24h; range = 0.10–0.69 mg/kg/d) was associated with a 2‐fold reduction in the risk of reaching the composite cardiac endpoint (adjusted HR = 0.47; 95% CI = 0.27–0.82; P = 0.0077) as compared with furosemide (median dose = 1.39 mg/kg q12h; range = 0.70–6.30 mg/kg q12h).Conclusions and Clinical ImportanceTorasemide q24h is an effective oral diuretic in dogs with CHF.

Coughing in dogs: what is the evidence for and against a cardiac cough?

“…Furthermore, an investigation of CHF secondary to mitral valve disease demonstrated 85% of the 366 dogs, with median body weight 7.5 kg, presented with coughing, with approximately half experiencing frequent or very frequent episodes of cough at the onset of CHF (Chetboul et al . ). However, there are other plausible, and perhaps more likely, explanations for the cause of coughing in these patients than pulmonary oedema alone.…”

ACVIM consensus guidelines for the diagnosis and treatment of myxomatous mitral valve disease in dogs

“… Continue PO furosemide administration to effect, commonly at a dosage of 2 mg/kg administered q12h, or as needed to maintain patient comfort. Some panelists now choose to substitute torsemide for furosemide at 1/10‐1/20 or approximately 5% to 10% of the furosemide dosage, or approximately 0.1‐0.3 mg/kg q24h for home care in animals in which hospitalized CHF management using furosemide was difficult or met with limited success. (Class I, LOE: moderate) Chronic PO furosemide dosages ≥8 mg/kg q24h in any dosing regimen (or the equipotent torsemide dosage) needed to maintain patient comfort in the face of appropriate dosages of pimobendan, an ACEI, and spironolactone indicate disease progression to Stage D. Consideration of known causes of diuretic resistance, including noncompliance (ie, not receiving the drug), high sodium intake, slow absorption (eg, gut edema), impaired secretion into the renal tubular lumen (eg, chronic kidney disease, advanced age, concurrent nonsteroidal anti‐inflammatory drug use), hypoproteinemia, hypotension, nephron remodeling, and neurohormonal activation is warranted.…”

Therapie der Mitralklappenendokardiose beim Hund – ein Update

“…Bei drei Hunden mit refraktärem Herzversagen unter Therapie mit Furosemid, Spironolacton und Hydrochlorothiazid konnte durch Wechsel von Furosemid auf Torasemid eine weitere Stabilisierung erreicht werden (64). Die aktuell publizierte TEST-Studie (17) mit Upcard® (Vetoquinol GmbH) verglich unter Verblindung bei 366 Hunden mit MKE im Stadium C die einmal tägliche Gabe von Torasemid mit der zweimal täglichen Gabe von Furosemid. Die Torasemiddosis betrug 1/10 bis 1/20 der Tagesgesamtdosis von Furosemid (mittlere Dosis 0,24 mg/kg/Tag bzw.…”