Amina A Alkhalaf, Rishi J Desai, Julie C Lauffenburger
{"title":"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。","authors":"Amina A Alkhalaf, Rishi J Desai, Julie C Lauffenburger","doi":"10.1002/pds.70130","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":19782,"journal":{"name":"Pharmacoepidemiology and Drug Safety","volume":"34 4","pages":"e70130"},"PeriodicalIF":2.4000,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Comparative Effectiveness and Safety of Torsemide Versus Furosemide in Older Adults With Heart Failure.\",\"authors\":\"Amina A Alkhalaf, Rishi J Desai, Julie C Lauffenburger\",\"doi\":\"10.1002/pds.70130\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>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.</p>\",\"PeriodicalId\":19782,\"journal\":{\"name\":\"Pharmacoepidemiology and Drug Safety\",\"volume\":\"34 4\",\"pages\":\"e70130\"},\"PeriodicalIF\":2.4000,\"publicationDate\":\"2025-04-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Pharmacoepidemiology and Drug Safety\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1002/pds.70130\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"PHARMACOLOGY & PHARMACY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Pharmacoepidemiology and Drug Safety","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1002/pds.70130","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"PHARMACOLOGY & PHARMACY","Score":null,"Total":0}
Comparative Effectiveness and Safety of Torsemide Versus Furosemide in Older Adults With Heart Failure.
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.
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.
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