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Ahmad Cheema H, Azeem S, Ejaz A, Khan F, Muhammad A, Shahid A, Nashwan AJ, Maqsood MH, Dani SS, Mentz RJ, Fudim M, Fonarow GC. Efficacy and safety of torsemide versus furosemide in heart failure patients: A systematic review of randomized controlled trials. Clin Cardiol 2024; 47:e24088. [PMID: 37608566 PMCID: PMC10765996 DOI: 10.1002/clc.24088] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/31/2023] [Accepted: 06/29/2023] [Indexed: 08/24/2023] Open
Affiliation(s)
- Huzaifa Ahmad Cheema
- Department of CardiologyKing Edward Medical UniversityLahorePakistan
- Department of MedicineKing Edward Medical UniversityLahorePakistan
| | - Saleha Azeem
- Department of MedicineKing Edward Medical UniversityLahorePakistan
| | - Abdullah Ejaz
- Department of MedicineKing Edward Medical UniversityLahorePakistan
| | - Faiza Khan
- Department of MedicineKing Edward Medical UniversityLahorePakistan
| | - Anza Muhammad
- Department of MedicineKing Edward Medical UniversityLahorePakistan
| | - Abia Shahid
- Department of MedicineKing Edward Medical UniversityLahorePakistan
| | | | | | - Sourbha S. Dani
- Division of Cardiovascular Medicine, Beth Israel Lahey HealthLahey Hospital and Medical CenterBurlingtonMassachusettsUSA
| | - Robert J. Mentz
- Division of Cardiology, Department of MedicineDuke University Medical CenterDurhamNorth CarolinaUSA
| | - Marat Fudim
- Department of MedicineDuke University Medical CenterDurhamNCUSA
- Duke Clinical Research InstituteDurhamNorth CarolinaUSA
| | - Gregg C. Fonarow
- Ahmanson‐UCLA Cardiomyopathy Center, Division of CardiologyUniversity of California Los AngelesLos AngelesCaliforniaUSA
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Singh S, Goel S, Duhan S, Chaudhary R, Garg A, Tantry US, Gurbel PA. Effect of Furosemide Versus Torsemide on Hospitalizations and Mortality in Patients With Heart Failure: A Meta-Analysis of Randomized Controlled Trials. Am J Cardiol 2023; 206:42-48. [PMID: 37677884 PMCID: PMC10824237 DOI: 10.1016/j.amjcard.2023.08.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/04/2023] [Accepted: 08/12/2023] [Indexed: 09/09/2023]
Abstract
Loop diuretics are essential in the treatment of patients with heart failure (HF) who develop congestion. Furosemide is the most commonly used diuretic; however, some randomized controlled trials (RCTs) have shown varying results associated with torsemide and furosemide in terms of hospitalizations and mortality. We performed an updated meta-analysis of currently available RCTs comparing furosemide and torsemide to see if there is any difference in clinical outcomes in patients treated with these loop diuretics. PubMed, MEDLINE, Cochrane, and Embase databases were searched for RCTs comparing the outcomes in patients with HF treated with furosemide versus torsemide. The primary end points included all-cause mortality, all-cause hospitalizations, cardiovascular-related hospitalizations, and HF-related hospitalizations. A random-effects meta-analysis was performed to estimate the risk ratio (RR) with a 95% confidence interval (CI). A total of 10 RCTs with 4,127 patients (2,088 in the furosemide group and 2,039 in the torsemide group) were included in this analysis. A total of 56% of the patients were men and the mean age was 68 years. No significant difference was noted in all-cause mortality between the furosemide and torsemide groups (RR 1.02, 95% CI 0.91 to 1.15, p = 0.70); however, patients treated with furosemide compared with torsemide had higher risks of cardiovascular hospitalizations (RR 1.36, 95% CI 1.13 to 1.65, p = 0.001), HF-related hospitalizations (RR 1.65, 95% CI 1.21 to 2.24, p = 0.001), and all-cause hospitalizations (RR 1.06, 95% CI 1.01 to 1.11, p = 0.02). In conclusion, patients with HF treated with torsemide have a reduced risk of hospitalizations compared with those treated with furosemide, without any difference in mortality. These data indicate that torsemide may be a better choice to treat patients with HF.
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Affiliation(s)
- Sahib Singh
- Department of Medicine, Sinai Hospital of Baltimore, Baltimore, Maryland.
| | - Swecha Goel
- Department of Medicine, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Sanchit Duhan
- Department of Medicine, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Rahul Chaudhary
- Division of Cardiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Aakash Garg
- Cardiology Associates of Schenectady, St. Peter's Health Partners, Albany, New York
| | - Udaya S Tantry
- Sinai Center for Thrombosis Research, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Paul A Gurbel
- Sinai Center for Thrombosis Research, Sinai Hospital of Baltimore, Baltimore, Maryland; Division of Cardiology, Sinai Hospital of Baltimore, Baltimore, Maryland
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Siddiqi AK, Javaid H, Ahmed M, Dhawadi S, Batool L, Zahid M, Muslim MO, Naeem K, Mahmood F, Hussain A. Clinical Outcomes With Furosemide Versus Torsemide in Patients With Heart Failure: An Updated Systematic Review and Meta-Analysis. Curr Probl Cardiol 2023; 48:101927. [PMID: 37453532 DOI: 10.1016/j.cpcardiol.2023.101927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 06/28/2023] [Accepted: 07/04/2023] [Indexed: 07/18/2023]
Abstract
Despite potential advantages of torsemide over furosemide, <10% of the patients with heart failure (HF) are on torsemide in clinical practice. Prior studies comparing furosemide to torsemide in patients with HF have shown conflicting findings, regarding hospitalizations and mortality. We aimed to pool all the studies conducted to date and provide the most updated and comprehensive evidence, regarding the effect of furosemide vs torsemide in reducing mortality and hospitalizations in patients with HF. We conducted a comprehensive literature search of the PubMed/Medline, Cochrane Library and Scopus from inception till June 2023, for randomized and nonrandomized studies comparing furosemide to torsemide in adult patients (>18 years) with acute or chronic HF. Data about all-cause mortality, HF-related hospitalizations and all-cause hospitalizations was extracted, pooled, and analyzed. Forest plots were created based on the random effects model. A total of 17 studies (n = 11,996 patients) were included in our analysis with a median follow-up time of 8 months. Our pooled analysis demonstrated no difference in all-cause mortality between furosemide and torsemide groups in HF patients (OR = 0.98, 95% CI: 0.75-1.29, P = 0.89). However, torsemide was associated with a significantly lesser incidence of HF-related hospitalizations (OR = 0.73, 95% CI: 0.54-0.99, P = 0.04), and all-cause hospitalizations (OR = 0.84, 95% CI: 0.73-0.98, P = 0.03), as compared to furosemide. Torsemide significantly reduces HF-related and all-cause hospitalizations as compared to furosemide, with no difference in mortality. We recommend transitioning from furosemide to torsemide in HF patients who are not attaining symptomatic control.
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Affiliation(s)
| | - Hira Javaid
- Department of Medicine, Allama Iqbal Medical College, Lahore, Pakistan
| | - Mushood Ahmed
- Department of Medicine, Rawalpindi Medical University, Rawalpindi, Pakistan
| | - Siwar Dhawadi
- Department of Medicine, Faculty of Medicine Monastir, Mosastir, Tunisia
| | - Laiba Batool
- Department of Medicine, CMH Institute of Medical Sciences, Multan, Pakistan
| | - Maheen Zahid
- Department of Medicine, Liaquat University of Medical and Health Sciences, Hyderabad, Pakistan
| | | | - Khadija Naeem
- Department of Medicine, Nishtar Medical University, Multan, Pakistan
| | - Fizza Mahmood
- Department of Medicine, Quaid-E-Azam Medical College, Bahawalpur, Pakistan
| | - Abbas Hussain
- Department of Medicine, Jinnah Medical and Dental College, Karachi, Pakistan
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Peters AE, Mentz RJ, DeWald TA, Greene SJ. An evaluation of torsemide in patients with heart failure and renal disease. Expert Rev Cardiovasc Ther 2022; 20:5-11. [PMID: 34936522 PMCID: PMC8887994 DOI: 10.1080/14779072.2022.2022474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Torsemide is a loop diuretic that inhibits the Na+/K+/2Cl- cotransporter type 2 in the thick ascending loop of Henle, leading to increased excretion of urinary sodium and chloride and associated diuresis. While furosemide remains the dominant diuretic utilized in current practice, increasing evidence supports potential advantages of torsemide in heart failure (HF) and/or renal disease. AREAS COVERED This narrative review covers the evidence for use of torsemide in HF and renal disease. Comparative effectiveness with regards to clinical outcomes is reviewed, as well as the ongoing multicenter trial, TRANSFORM-HF, comparing the effect of torsemide versus furosemide among patients with HF. EXPERT OPINION Compared with furosemide, torsemide has favorable pharmacodynamics/pharmacokinetics including higher bioavailability, longer duration of effect, minor renal excretion, decreased kaliuresis, and enhanced natriuresis/diuresis. These properties may be further supported by differential effects on RAAS regulation and fibrosis modulation as compared with other diuretics. The limited current body of evidence indicates that torsemide may be superior to furosemide with respect to improving HF functional status and reducing HF hospitalization, and there are mixed data regarding effect on reducing overall cardiovascular hospitalizations/mortality. Further, randomized data are necessary to definitively determine if torsemide can reduce risk of mortality and hospitalization among patients with HF.
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Affiliation(s)
- Anthony E. Peters
- Duke Clinical Research Institute and Division of Cardiology, Duke University School of Medicine, Durham, North Carolina
| | - Robert J. Mentz
- Duke Clinical Research Institute and Division of Cardiology, Duke University School of Medicine, Durham, North Carolina
| | - Tracy A. DeWald
- Division of Clinical Pharmacology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Stephen J. Greene
- Duke Clinical Research Institute and Division of Cardiology, Duke University School of Medicine, Durham, North Carolina
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Coussanes E, Guillot E, Magnier R, Geneteau A, Elliott J. Safety of torasemide in healthy adult dogs administered daily for 26 weeks. J Vet Pharmacol Ther 2021; 45:153-166. [PMID: 34791658 PMCID: PMC9298703 DOI: 10.1111/jvp.13030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 10/15/2021] [Accepted: 10/18/2021] [Indexed: 11/30/2022]
Abstract
Thirty‐two (16 males and 16 females) healthy young beagles were randomly divided into four groups of eight. The control group remained untreated. Torasemide (ISEMID®, Ceva Santé Animale) was orally administered, once daily, at 0.5 mg/kg from Days 1–5 then 0.25 mg/kg to Day 182, and at three times and five times this dosing regimen in two additional groups. Treated animals (predominantly at the higher dose levels) showed dryness of the oral mucosa, evidence of diuresis, decreased diet consumption, decreased bodyweight gain over the first 3 weeks, increased water consumption, increases in erythrocytes count, haemoglobin, calcium and magnesium, decrease in chloride, phosphorus, potassium and sodium, increases in urine pH, decreases in urine specific gravity and increases in serum aldosterone concentrations. Plasma concentrations of torasemide increased in a dose‐dependent manner and showed no evidence of accumulation. There were also changes to electrocardiogram patterns and the macroscopic and microscopic appearance of the kidney and adrenal glands, but these changes were almost exclusively confined to the over‐dosed groups. In conclusion, torasemide was found to be safe when administered to dogs at 0.25 mg/kg once daily for 26 weeks, and any changes were consistent with its known diuretic effects.
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Besche B, Blondel T, Guillot E, Garelli-Paar C, Oyama MA. Efficacy of oral torasemide in dogs with degenerative mitral valve disease and new onset congestive heart failure: The CARPODIEM study. J Vet Intern Med 2020; 34:1746-1758. [PMID: 32767627 PMCID: PMC7517836 DOI: 10.1111/jvim.15864] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 07/15/2020] [Accepted: 07/21/2020] [Indexed: 12/21/2022] Open
Abstract
Background Torasemide is a potent loop diuretic with potential to treat congestive heart failure (CHF) in dogs. Objective Evaluate the efficacy and safety of torasemide compared to furosemide in dogs with first occurrence of CHF caused by degenerative mitral valve disease (DMVD). Animals Three hundred and nineteen dogs with new onset CHF attributable to DMVD. Methods Double‐blinded randomized noninferiority study of PO torasemide vs furosemide in addition to standard CHF treatment. The primary efficacy criterion was decreased pulmonary edema and cough and no worsening of dyspnea or exercise tolerance at day 14. Secondary endpoints included clinical response at day 84 and time to death, euthanasia, or premature study withdrawal for cardiac reasons. Results Torasemide q24h (n = 161) was noninferior to furosemide q12h (n = 158); percentage of dogs meeting primary efficacy criterion at day 14 was similar between groups (torasemide, 74.4% [95% confidence interval (CI), 66.8%‐81.0%] vs. furosemide, 73.5% [95% CI, 65.7%‐80.4%]; risk ratio [RR], 1.01; 95% CI, 0.89‐1.15; P = .87). Efficacy at day 84 showed similar results (RR, 1.05; 95% CI, 0.88‐1.25; P = .6). Dogs receiving torasemide had a longer time to endpoint and were less than half as likely to experience death, euthanasia, or premature study withdrawal (hazard ratio, 0.36; 95% CI, 0.19‐0.65; P = .001) than dogs receiving furosemide at any time during the study. Conclusion and Clinical importance Torasemide was noninferior to furosemide as first line PO treatment for new onset CHF caused by DMVD. Torasemide significantly decreased risk of cardiac‐related death or premature study withdrawal for cardiac reasons compared to furosemide.
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Affiliation(s)
| | | | | | | | - Mark A Oyama
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Sherif NA, Morra ME, Thanh LV, Elsayed GG, Elkady AH, Elshafay A, Kien ND, Al-Habbaa A, Minh LHN, Y MN, Nghia TLB, Mohammed AT, Eid PS, Turk T, Hirayama K, Huy NT. Torasemide versus furosemide in treatment of heart failure: A systematic review and meta-analysis of randomized controlled trials. J Eval Clin Pract 2020; 26:842-851. [PMID: 31436024 DOI: 10.1111/jep.13261] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 07/27/2019] [Indexed: 12/30/2022]
Abstract
AIM Diuretics are a cornerstone in treatment of heart failure (HF). Torasemide is a loop diuretic with a potential advantage over other diuretics. We aim to meta-analyse and compare the effect of torasemide with furosemide in HF patients. METHODS A comprehensive literature search using 12 databases including PubMed, Scopus, and Web of Science was performed. All randomized controlled trials (RCTs) comparing furosemide and torasemide in HF patients were included and meta-analysed. We assessed the risk of bias using Cochrane Collaboration's tool. The protocol was registered in PROSPERO (CRD42016046112). RESULTS Eighteen RCTs with 1598 patients were included. There was a significant difference between torasemide 20 mg and furosemide 40 mg in increasing the urine volume (standard difference of the mean (SDM) [95% confidence interval] = -0.78 [-1.52 to -0.053], P = .036). Torasemide 10 mg and 10 to 20 mg have a significant effect on potassium excretion in comparison with furosemide 25 to 40 mg (P = .018 and .023, respectively). In general, torasemide and furosemide have no significant difference in mortality, edema improvement, weight loss, heart rate, and reducing systolic/diastolic blood pressure. However, oral torasemide has a significant lower hospital stay P < .001 and superior effect in improving ejection fraction P = .029. CONCLUSION Although not all results are statistically significant, torasemide has potential advantages on multiple aspects of HF management when compared with furosemide. More studies are needed to clarify these effects.
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Affiliation(s)
- Nourin Ali Sherif
- Faculty of Medicine, Mansoura University, Mansoura, Egypt.,Online Research Club, Nagasaki, Japan
| | | | - Le Van Thanh
- Online Research Club, Nagasaki, Japan.,Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Ghadeer Gamal Elsayed
- Online Research Club, Nagasaki, Japan.,Faculty of Medicine, Benha University, Benha, Egypt
| | - Aya Hesham Elkady
- Online Research Club, Nagasaki, Japan.,Faculty of Medicine, Menoufia University, Shebin El-Kom, Egypt
| | - Abdelrahman Elshafay
- Online Research Club, Nagasaki, Japan.,Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Nguyen Dang Kien
- Department of Obstetrics and Gynecology, Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
| | - Ahmed Al-Habbaa
- Cardiology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Le Huu Nhat Minh
- Online Research Club, Nagasaki, Japan.,Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Mai Nhu Y
- Online Research Club, Nagasaki, Japan.,Faculty of Medicine, Vo Truong Toan University, Hau Giang, Vietnam
| | - Thai Le Ba Nghia
- Online Research Club, Nagasaki, Japan.,Faculty of Medicine, Vo Truong Toan University, Hau Giang, Vietnam
| | | | - Peter Samuel Eid
- Online Research Club, Nagasaki, Japan.,Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Tarek Turk
- Faculty of Medicine, Damascus University, Damascus, Syria
| | - Kenji Hirayama
- Department of Immunogenetics, Institute of Tropical Medicine (NEKKEN), Leading Graduate School Program, and Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Nguyen Tien Huy
- Evidence Based Medicine Research Group, Ton Duc Thang University, Ho Chi Minh City, Vietnam.,Faculty of Applied Sciences, Ton Duc Thang University, Ho Chi Minh City, Vietnam
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Vascular Protection and Decongestion Without Renin–Angiotensin–Aldosterone System Stimulation Mediated by a Novel Dual-Acting Vasopressin V1a/V2 Receptor Antagonist. J Cardiovasc Pharmacol 2019; 74:44-52. [DOI: 10.1097/fjc.0000000000000677] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Miles JA, Hanumanthu BK, Patel K, Chen M, Siegel RM, Kokkinidis DG. Torsemide versus furosemide and intermediate-term outcomes in patients with heart failure. J Cardiovasc Med (Hagerstown) 2019; 20:379-388. [DOI: 10.2459/jcm.0000000000000794] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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