Effects and safety of oral tolvaptan in patients with congestive heart failure: A systematic review and network meta-analysis

Mei Yi Wu, Tzu Ting Chen, Ying Chun Chen, Der Cherng Tarng, Yun Chun Wu, Hsien Ho Lin, Yu Kang Tu

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Aims: Several studies reported treatment benefits of tolvaptan in patients with congestive heart failure (CHF). However, the optimal dosage remains unclear. We aimed to compare different dosage of tolvaptan to determine the optimal dosage in terms of the efficacy and safety. Methods: We searched MEDLINE, PubMed, EMBASE, Cochrane CENTRAL and ClinicalTrials.gov through Aug 31, 2016. Randomized controlled trials (RCTs) comparing tolvaptan of different dosages or to placebo in patients with CHF were included. We used network meta-analysis to look for the optimal dosage in terms of effectiveness and safety. Urine output, body weight change and change in serum sodium were the main outcomes of efficacy. Adverse effects were the secondary outcomes. Quality was assessed by Cochrane risk-of-bias tool. Results: Twelve RCTs reporting 14 articles with 5793 patients (mean age, 65.7 ± 11.9 years; 73.7% man) were included. Compared with placebo, the tolvaptan 30 mg had similar effects to tolvaptan 45–90 mg in terms of urine output (mean difference [MD] 2.03 liter; 95% confidence interval [CI] 1.3 to 2.71), body weight change (MD -1.12 kg; 95% CI -1.37 to -0.88) and change in serum sodium (MD 3.06 meq/L; 95% CI 2.43 to 3.68). Compared with placebo, tolvaptan of different dosage showed a non-significant higher risk of adverse effects. Conclusions: These findings suggest that tolvaptan 30 mg and 45 mg may be the optimum dosage for CHF patients, because of its ability to provide favourable clinical results without greater adverse effects. However, tolvaptan is not beneficial for reducing all-cause mortality in CHF patients.

Original languageEnglish
Article numbere0184380
JournalPLoS One
Volume12
Issue number9
DOIs
Publication statusPublished - Sep 1 2017

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systematic review
heart failure
meta-analysis
mouth
Heart Failure
Safety
dosage
placebos
confidence interval
adverse effects
body weight changes
Body Weight Changes
Placebos
Confidence Intervals
urine
sodium
Randomized Controlled Trials
Sodium
Urine
Network Meta-Analysis

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

Effects and safety of oral tolvaptan in patients with congestive heart failure : A systematic review and network meta-analysis. / Wu, Mei Yi; Chen, Tzu Ting; Chen, Ying Chun; Tarng, Der Cherng; Wu, Yun Chun; Lin, Hsien Ho; Tu, Yu Kang.

In: PLoS One, Vol. 12, No. 9, e0184380, 01.09.2017.

Research output: Contribution to journalArticle

Wu, Mei Yi ; Chen, Tzu Ting ; Chen, Ying Chun ; Tarng, Der Cherng ; Wu, Yun Chun ; Lin, Hsien Ho ; Tu, Yu Kang. / Effects and safety of oral tolvaptan in patients with congestive heart failure : A systematic review and network meta-analysis. In: PLoS One. 2017 ; Vol. 12, No. 9.
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AB - Aims: Several studies reported treatment benefits of tolvaptan in patients with congestive heart failure (CHF). However, the optimal dosage remains unclear. We aimed to compare different dosage of tolvaptan to determine the optimal dosage in terms of the efficacy and safety. Methods: We searched MEDLINE, PubMed, EMBASE, Cochrane CENTRAL and ClinicalTrials.gov through Aug 31, 2016. Randomized controlled trials (RCTs) comparing tolvaptan of different dosages or to placebo in patients with CHF were included. We used network meta-analysis to look for the optimal dosage in terms of effectiveness and safety. Urine output, body weight change and change in serum sodium were the main outcomes of efficacy. Adverse effects were the secondary outcomes. Quality was assessed by Cochrane risk-of-bias tool. Results: Twelve RCTs reporting 14 articles with 5793 patients (mean age, 65.7 ± 11.9 years; 73.7% man) were included. Compared with placebo, the tolvaptan 30 mg had similar effects to tolvaptan 45–90 mg in terms of urine output (mean difference [MD] 2.03 liter; 95% confidence interval [CI] 1.3 to 2.71), body weight change (MD -1.12 kg; 95% CI -1.37 to -0.88) and change in serum sodium (MD 3.06 meq/L; 95% CI 2.43 to 3.68). Compared with placebo, tolvaptan of different dosage showed a non-significant higher risk of adverse effects. Conclusions: These findings suggest that tolvaptan 30 mg and 45 mg may be the optimum dosage for CHF patients, because of its ability to provide favourable clinical results without greater adverse effects. However, tolvaptan is not beneficial for reducing all-cause mortality in CHF patients.

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