Tolvaptan Useful in Short-Term Dyspnea Relief During HF Hospitalization

The following article is a part of conference coverage from the American Heart Association Scientific Sessions 2021, being held virtually from November 13 to 15, 2021. The team at Cardiology Advisor will be reporting on the latest news and research conducted by leading experts in cardiology. Check back for more from the AHA Scientific Sessions 2021.

Treatment with tolvaptan can provide short-term symptomatic dyspnea relief but offers no advantage in reducing rehospitalization rates and mortality in hospitalized patients with heart failure (HF), according to study results presented at the American Heart Association (AHA) Scientific Sessions 2021, held from November 13 to 15, 2021.

In this meta-analysis to evaluate the additive effect of tolvaptan in hospitalized patients with HF, researchers identified randomized controlled trials that studied the effects of tolvaptan vs placebo that were published in PubMed, EMBASE, Cochrane Library, and Web of Science databases. Researchers included studies with any of the following endpoints: mortality, rehospitalization, and in-hospital parameters, such as dyspnea relief, change in weight, sodium, and creatinine.

Data from 14 studies were analyzed (N=5945 patients); follow-up duration ranged from 30 days to 2 years. There was no difference between the tolvaptan and placebo groups in mortality (relative risk [RR], 0.73; 95% CI, 0.46-1.18; P =.2) and rehospitalization (RR, 0.79; 95% CI, 0.51-1.22; P =.28). HF patients had a better dyspnea relief score (Likert score) in the tolvaptan group (RR, 1.19; 95% CI, 1.06-1.33; P =.003) and mean reduction in weight in the first 48 hours (mean difference [MD], -2.19; 95% CI, -.35 to -0.86; P =.001). The MD in weight was not significant after 7 days (MD, -0.67; 95% CI, -1.45 to 0.11; P =.09). Serum sodium increased significantly in the tolvaptan group (MD, 3.75; 95% CI, 2.92-4.58; P <.00001). Between the 2 groups, there was no difference in creatinine (MD, 0.00; 95% CI, -0.08 to 0.08; P =.98).

“Our meta-analysis shows that during hospitalization of HF patients, tolvaptan can be useful in short-term symptomatic dyspnea relief and initial reduction in weight due to its additive diuretic effect,” the researchers concluded. “However, this benefit is short-lived, and there is no advantage in reducing rehospitalization rates and mortality. Further, tolvaptan is not effective for sustained and long term weight loss.”

Reference

Kansara T, Gandhi H, Kumar A, et al. Tolvaptan add-on therapy on efficacy parameters and outcomes in patients hospitalized with acute heart failure. Presented at: AHA 2021; November 13-15, 2021. Poster P1887.