Comparative Effectiveness and Safety of Torsemide Versus Furosemide in Older Adults With Heart Failure.

IF 2.4 4区医学 Q3 PHARMACOLOGY & PHARMACY

Pharmacoepidemiology and Drug Safety Pub Date : 2025-04-01 DOI:10.1002/pds.70130

Amina A Alkhalaf, Rishi J Desai, Julie C Lauffenburger

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引用次数: 0

Abstract

Purpose: Evidence on the real-world comparative effectiveness and safety of commonly used loop diuretics for heart failure is mixed, particularly among older adults who are at a higher risk of adverse outcomes. Thus, we aimed to compare the outcomes and safety profiles of torsemide and furosemide.

Methods: We conducted a new user, active comparator retrospective cohort study comparing torsemide to furosemide in Medicare fee-for-service beneficiaries with heart failure in claims data (2008-2020). Effectiveness outcomes were a composite of heart failure hospitalization or death and urgent outpatient visits requiring intravenous diuretics; safety outcomes included acute kidney injury, hypovolemia, and hypokalemia. We used 1:4 propensity score (PS) matching to adjust for confounding. We calculated PS-matched hazard ratios using Cox proportional hazard models.

Results: Across 328 640 matched beneficiaries, compared with furosemide, torsemide was associated with a similar, though statistically significantly lower, risk of the composite effectiveness outcome (hazard ratio [HR] = 0.97, 95% CI:0.95,0.99; incidence rate difference (IRD) = -3.79, 95% CI:-9.38,1.81 events per 1000 person-years) and lower risk for urgent visits with intravenous loop diuretics (HR = 0.88, 95% CI:0.84,0.92; IRD = -7.03, 95% CI:-9.79,-4.26 events per 1000 person-years). Torsemide was also associated with an increased risk of acute kidney injury (HR = 1.12, 95% CI:1.10,1.15; IRD = 36.89, 95% CI:31.51,42.64 events per 1000 person-years) with no observed difference in hypokalemia (HR = 1.02, 95% CI:0.91,1.14; IRD = 0.46, 95% CI:-0.51,1.42 events per 1000 person-years) and hypovolemia (HR = 1.03, 95% CI:0.98,1.09; IRD = 2.36, 95% CI:0.15,4.56 events per 1000 person-years).

Conclusions: Compared with furosemide, initiation of torsemide was associated with a slightly lower risk of a composite of all-cause mortality or heart failure hospitalization and urgent visits with intravenous diuretics, but a slightly higher risk of acute kidney injury. In older adults, clinicians must balance torsemide's potential benefits with the acute kidney injury risk.

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托尔塞米与速尿在老年心力衰竭患者中的有效性和安全性比较。

目的：有关治疗心力衰竭的常用襻利尿剂的实际效果和安全性比较的证据不一，尤其是在不良后果风险较高的老年人中。因此，我们旨在比较托塞米和呋塞米的疗效和安全性：我们进行了一项新用户、主动比较的回顾性队列研究，在报销数据（2008-2020 年）中，我们对医疗保险付费服务受益人中的心力衰竭患者进行了托昔米与呋塞米的比较。疗效结果是心衰住院或死亡和需要静脉注射利尿剂的紧急门诊就诊的综合结果；安全性结果包括急性肾损伤、低血容量和低钾血症。我们使用 1:4 倾向评分（PS）匹配来调整混杂因素。我们使用 Cox 比例危险模型计算了 PS 匹配的危险比：结果：在 328 640 名匹配的受益人中，与呋塞米相比，托瑞米的综合疗效风险相似，但在统计学上显著较低（危险比 [HR] = 0.97，95% CI:0.95,0.99；发病率差异（IRD）=-3.79，95% CI：-9.38,1.81 次/1000 人-年），静脉注射襻利尿剂的急诊风险较低（HR = 0.88，95% CI：0.84,0.92；IRD = -7.03，95% CI：-9.79,-4.26 次/1000 人-年）。托西米还与急性肾损伤风险增加有关（HR = 1.12，95% CI：1.10,1.15；IRD = 36.89，95% CI：31.51,42.64 次/1000 人-年），但在低钾血症方面未观察到差异（HR = 1.02，95% CI：0.91,1.14；IRD = 0.46，95% CI：-0.51,1.42 次/1000 人-年）和低血容量（HR = 1.03，95% CI：0.98,1.09；IRD = 2.36，95% CI：0.15,4.56 次/1000 人-年）方面没有观察到差异：与呋塞米相比，开始使用托瑞米时，全因死亡率或心衰住院和静脉注射利尿剂急诊的复合风险略低，但急性肾损伤的风险略高。对于老年人，临床医生必须在托昔米的潜在益处与急性肾损伤风险之间取得平衡。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pharmacoepidemiology and Drug Safety 医学-药学

CiteScore

4.80

自引率

7.70%

发文量

173

审稿时长

3 months

期刊介绍： The aim of Pharmacoepidemiology and Drug Safety is to provide an international forum for the communication and evaluation of data, methods and opinion in the discipline of pharmacoepidemiology. The Journal publishes peer-reviewed reports of original research, invited reviews and a variety of guest editorials and commentaries embracing scientific, medical, statistical, legal and economic aspects of pharmacoepidemiology and post-marketing surveillance of drug safety. Appropriate material in these categories may also be considered for publication as a Brief Report. Particular areas of interest include: design, analysis, results, and interpretation of studies looking at the benefit or safety of specific pharmaceuticals, biologics, or medical devices, including studies in pharmacovigilance, postmarketing surveillance, pharmacoeconomics, patient safety, molecular pharmacoepidemiology, or any other study within the broad field of pharmacoepidemiology; comparative effectiveness research relating to pharmaceuticals, biologics, and medical devices. Comparative effectiveness research is the generation and synthesis of evidence that compares the benefits and harms of alternative methods to prevent, diagnose, treat, and monitor a clinical condition, as these methods are truly used in the real world; methodologic contributions of relevance to pharmacoepidemiology, whether original contributions, reviews of existing methods, or tutorials for how to apply the methods of pharmacoepidemiology; assessments of harm versus benefit in drug therapy; patterns of drug utilization; relationships between pharmacoepidemiology and the formulation and interpretation of regulatory guidelines; evaluations of risk management plans and programmes relating to pharmaceuticals, biologics and medical devices.