A Systematic Review and Meta-Analysis of Metolazone Compared to Chlorothiazide for Treatment of Acute Decompensated Heart Failure.
chlorothiazide
diuretic
diuretic resistance
heart failure
metolazone
sequential nephron blockade
thiazide
Journal
Pharmacotherapy
ISSN: 1875-9114
Titre abrégé: Pharmacotherapy
Pays: United States
ID NLM: 8111305
Informations de publication
Date de publication:
09 2020
09 2020
Historique:
pubmed:
9
7
2020
medline:
10
8
2021
entrez:
9
7
2020
Statut:
ppublish
Résumé
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.
Substances chimiques
Diuretics
0
Chlorothiazide
77W477J15H
Metolazone
TZ7V40X7VX
Types de publication
Journal Article
Meta-Analysis
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
924-935Informations de copyright
© 2020 Pharmacotherapy Publications, Inc.
Références
Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2013;128:e240-327.
Jentzer JC, DeWald TA, Hernandez AF. Combination of loop diuretics with thiazide-type diuretics in heart failure. J Am Coll Cardiol 2010;56:1527-34.
Hoorn EJ, Ellison DH. Diuretic resistance. Am J Kidney Dis 2017;69(1):136-42.
Chlorothiazide [Package Insert]. Schaumburg, IL: Sagent Pharmaceuticals; 2014.
Metolazone [Package Insert]. Morgantown, WV: Mylan Pharmaceuticals, Inc; 2004.
Sica DA, Gehr TWB. Diuretic combinations in refractory oedema states. Clin Pharmacokinet 1996;30(3):229-49.
Tilstone WJ, Dargie H, Dargie EN, Morgan HG, Kennedy AC. Pharmacokinetics of metolazone in normal subjects and in patients with cardiac or renal failure. Clin Pharmacol Ther 1974;16:322-9.
Asscher AW. Treatment of furosemide resistant edema with metolazone. Clin Trials J 1974;4:134-9.
Dreyer NA, Bryant A, Velentgas P. The GRACE checklist: a validated assessment tool for high quality observational studies of comparative effectiveness. J Manag Care Spec Pharm 2016;22:1107-13.
Moranville MP, Choi S, Hogg J, et al. Comparison of metolazone versus chlorothiazide in acute decompensated heart failure with diuretic resistance. Cardiovasc Ther 2015;33:42-9.
Schulenberger CE, Jiang A, Devabhakthuni S, et al. Efficacy and safety of intravenous chlorothiazide versus oral metolazone in patients with acute decompensated heart failure and loop diuretic resistance. Pharmacother 2016;36(8):852-60.
Bohn BC, Hadgu RM, Pope HE, Shuster JE. Oral metolazone versus intravenous chlorothiazide as an adjunct to diuresis in acute decompensated heart failure with reduced ejection fraction. Hosp Pharm 2019;54(6):351-7.
Cox ZL, Hung R, Lenihan DJ, Testani JM. Diuretic strategies for loop diuretic resistance in acute heart failure: the 3T trial. JACC Heart Fail 2019 [Epub ahead of print]. https://doi.org/10.1016/j.jchf.2019.09.012
Cox ZL, Testani JM. Loop diuretic resistance complicating acute heart failure. Heart Fail Rev 2020;25(1):133-45.
Prospective comparison of metolazone versus chlorothiazide for acute decompensated heart failure with diuretic resistance - ClinicalTrials.gov. https://clinicaltrials.gov/ct2/show/NCT03574857. Accessed January 18, 2020.
Cardinale M, Altshuler J, Testani JM. Efficacy of intravenous chlorothiazide for refractory acute decompensated heart failure unresponsive to adjunct metolazone. Pharmacother 2016;36(8):843-51.