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Boriani G, Blomström-Lundqvist C, Hohnloser SH, Bergfeldt L, Botto GL, Capucci A, Lozano IF, Goette A, Israel CW, Merino JL, Camm AJ. Safety and efficacy of dronedarone from clinical trials to real-world evidence: implications for its use in atrial fibrillation. Europace 2020; 21:1764-1775. [PMID: 31324921 DOI: 10.1093/europace/euz193] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 06/20/2019] [Indexed: 12/27/2022] Open
Abstract
Efficacy and safety of dronedarone was shown in the ATHENA trial for paroxysmal or persistent atrial fibrillation (AF) patients. Further trials revealed safety concerns in patients with heart failure and permanent AF. This review summarizes insights from recent real-world studies and meta-analyses, including reports on efficacy, with focus on liver safety, mortality risk in patients with paroxysmal/persistent AF, and interactions of dronedarone with direct oral anticoagulants. Reports of rapidly progressing liver failure in dronedarone-prescribed patients in 2011 led to regulatory cautions about potential liver toxicity. Recent real-world evidence suggests dronedarone liver safety profile is similar to other antiarrhythmics and liver toxicity could be equally common with many Class III antiarrhythmics. Dronedarone safety concerns (increased mortality in patients with permanent AF) were raised based on randomized controlled trials (RCT) (ANDROMEDA and PALLAS), but comedication with digoxin may have increased the mortality rates in PALLAS, considering the dronedarone-digoxin pharmacokinetic (PK) interaction. Real-world data on apixaban-dronedarone interactions and edoxaban RCT observations suggest no significant safety risks for these drug combinations. Median trough plasma concentrations of dabigatran 110 mg during concomitant use with dronedarone are at acceptable levels, while PK data on the rivaroxaban-dronedarone interaction are unavailable. In RCTs and real-world studies, dronedarone significantly reduces AF burden and cardiovascular hospitalizations, and demonstrates a low risk for proarrhythmia in patients with paroxysmal or persistent AF. The concerns on liver safety must be balanced against the significant reduction in hospitalizations in patients with non-permanent AF and low risk for proarrhythmias following dronedarone treatment.
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Affiliation(s)
- Giuseppe Boriani
- Division of Cardiology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | | | - Stefan H Hohnloser
- Division of Clinical Electrophysiology, Department of Cardiology, J W Goethe University, Frankfurt, Germany
| | - Lennart Bergfeldt
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Västra Götaland, Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | | | | | - Andreas Goette
- Medical Clinic II, Cardiology Department, St Vincenz-Krankenhaus Paderborn, Paderborn, Germany.,Working Group Molecular Electrophysiology, University Hospital Magdeburg, Magdeburg, Germany
| | - Carsten W Israel
- Division of Clinical Electrophysiology, Department of Cardiology, J W Goethe University, Frankfurt, Germany.,Clinic of Internal Medicine, Bethel-Clinic, Bielefeld, Germany
| | - José L Merino
- Arrhythmia & Robotic EP Unit, Hospital Universitario La Paz-IdiPaz, Madrid, Spain
| | - A John Camm
- Cardiology Clinical Academic Group, Molecular and Clinical Sciences Institute, St George's University of London, Cranmer Terrace, London SW17 0RE, UK
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Ehrlich JR, Look C, Kostev K, Israel CW, Goette A. Impact of dronedarone on the risk of myocardial infarction and stroke in atrial fibrillation patients followed in general practices in Germany. Int J Cardiol 2019; 278:126-132. [DOI: 10.1016/j.ijcard.2018.11.133] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 09/15/2018] [Accepted: 11/30/2018] [Indexed: 11/30/2022]
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Capucci A, Cipolletta L, Guerra F, Giannini I. Emerging pharmacotherapies for the treatment of atrial fibrillation. Expert Opin Emerg Drugs 2018; 23:25-36. [PMID: 29508636 DOI: 10.1080/14728214.2018.1446941] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION The main aim of current research on the field of atrial fibrillation (AF) treatment is to find new antiarrhythmic drugs with less side effects. Areas covered: Dronedarone and vernakalant showed promising result in term of efficacy and safety in selected patients. Ranolazine and colchicine are obtaining a role as a potential antiarrhythmic drug. Ivabradine is used in experimental studies for the rate control of AF. Moreover, new compounds (vanoxerine, moxonidine, budiodarone) are still under investigation. Monoclonal antibodies or selective antagonist of potassium channel are under investigation for long term maintenance of sinus rhythm. Clinical evidence and new pharmacological investigation on new drugs will be accurately reviewed in this article. Expert opinion: Dronedarone use is not recommended in patients with symptomatic heart failure (HF), NYHA class III-IV, depressed ventricular function and permanent AF, especially in patients assuming a concomitant therapy with digoxin. Vernakalant had superior efficacy than amiodarone, flecainide and propafenone in single studies and similar efficacy to direct current cardioversion. Several of the developing drugs examined in this paper show an interesting potential, in particular the research on selective ionic channel inhibition and on compounds which reduce the inflammation state, especially after ablation or surgery.
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Affiliation(s)
- Alessandro Capucci
- a Department of Scienze Cardiovascolari , Clinica di Cardiologia Universita' Politecnica delle Marche - Scienze Cardiovascolari , Ancona , Italy
| | - Laura Cipolletta
- a Department of Scienze Cardiovascolari , Clinica di Cardiologia Universita' Politecnica delle Marche - Scienze Cardiovascolari , Ancona , Italy
| | - Federico Guerra
- a Department of Scienze Cardiovascolari , Clinica di Cardiologia Universita' Politecnica delle Marche - Scienze Cardiovascolari , Ancona , Italy
| | - Irene Giannini
- a Department of Scienze Cardiovascolari , Clinica di Cardiologia Universita' Politecnica delle Marche - Scienze Cardiovascolari , Ancona , Italy
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Guerra F, Romandini A, Barbarossa A, Belardinelli L, Capucci A. Ranolazine for rhythm control in atrial fibrillation: A systematic review and meta-analysis. Int J Cardiol 2017; 227:284-291. [DOI: 10.1016/j.ijcard.2016.11.103] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 11/06/2016] [Indexed: 12/19/2022]
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