Eplerenone is not superior to older and less expensive aldosterone antagonists.

Abstract

INTRODUCTION:

Eplerenone is publicized to be extremely effective in reducing mortality from heart failure, with a reasonable side-effect profile. However, it is much more expensive compared with older aldosterone antagonists. We reviewed available evidence to assess whether increased expense was justified with outcomes data.

METHODS AND RESULTS:

The authors searched the PubMed, CENTRAL, CINAHL, and EMBASE databases for randomized controlled trials from 1966 through July 2011. Interventions included aldosterone antagonists (Aldactone [Pfizer, NY, NY], canrenone, eplerenone) in systolic heart failure. The comparator included standard medical therapy or placebo, or both. Outcomes assessed were mortality in the intervention versus the comparator groups, and rates of adverse events at the end of at least 8 weeks of follow-up. Event rates were compared using a forest plot of relative risk (RR) (95% confidence interval [CI]) using a random-effects model (Mantel-Haenszel) between the aldosterone antagonists and controls. We included 13 studies for aldosterone antagonists other than eplerenone, and 3 studies for eplerenone. There was significant reduction of mortality with all aldosterone antagonists, but eplerenone (15% mortality relative reduction; RR 0.85; 95% CI, 0.77-0.93; P=.0007) was outperformed by other aldosterone antagonists, namely, spironolactone and canrenone (26% mortality relative reduction; RR 0.74; 95% CI, 0.66-0.83; P <.0001). Reduction in cardiovascular mortality with eplerenone was 17% (RR 0.83; 95% CI, 0.75-0.92; P=.0005), while that with other aldosterone antagonists was 25% (RR 0.75; 95% CI, 0.67-0.84, P <.0001), without contributing significantly to an improved side-effect profile.

CONCLUSION:

Eplerenone does not appear to be more effective in reducing clinical events compared with older, less expensive aldosterone antagonists.

• Authors: Saurav Chatterjee, Chaim Moeller, Nidhi Shah, Oluwaseyi Bolorunduro, Edgar Lichstein, Norbert Moskovits, Debabrata Mukherjee
• Journal: The American journal of medicine (Am J Med) Vol. 125 Issue 8 Pg. 817-25 (Aug 2012) ISSN: 1555-7162 [Electronic] United States
• PMID: 22840667 (Publication Type: Comparative Study, Journal Article, Review)
• Copyright: Copyright © 2012 Elsevier Inc. All rights reserved.

Chemical References

• Mineralocorticoid Receptor Antagonists
• Spironolactone
• Eplerenone
• Canrenone

Topics

• Canrenone (economics, therapeutic use)
• Cause of Death
• Cost-Benefit Analysis
• Drug Costs (statistics & numerical data)
• Eplerenone
• Heart Failure (drug therapy, economics, mortality)
• Humans
• Mineralocorticoid Receptor Antagonists (economics, therapeutic use)
• Spironolactone (analogs & derivatives, economics, therapeutic use)
• Survival Rate
• Treatment Outcome