April 10, 2013
Less Common Loop Diuretic Demonstrates Greatest Benefits

New Haven, CT—Correspondence from Yale School of Medicine researchers could potentially change the way loop diuretics are prescribed in hospitalized heart failure patients.

The report, published online by the Journal of the American College of Cardiology, compared the effectiveness of three loop diuretics: toresemide, furosemide, and bumetanide. Interestingly, it found that the least prescribed drug appears to also have the greatest benefit.

“Loop diuretics are a cornerstone of heart failure treatment, so it is vital to understand the comparative effectiveness and real-world use of the drugs within this class,” said lead author Behnood Bikdeli, MD, postdoctoral associate in cardiovascular medicine at the Yale Center for Outcomes Research and Evaluation.

Using data from the Perspective database, a voluntary, fee-supported database of more than 500 U.S. hospitals developed by Premier, Inc., Yale researchers determined that, among 274,515 patients hospitalized for heart failure during 2009 and 2010, 92% received loop diuretics during their hospital stay. Of those, 87% received furosemide as their only loop diuretic, 3% received bumetanide, and only 0.4% received torsemide, with 10% receiving a combination of the agents.

While slightly more expensive, torsemide has been shown in studies to last longer and be better tolerated than the more commonly used loop diuretics, according to the correspondence.

“Most patients with HF received a loop diuretic. However, torsemide, a new agent with potentially superior clinical effectiveness, was rarely used,” the authors write. “Given the common usage of loop diuretics in HF and their potential non-equivalence in HF outcomes and safety endpoints, perhaps it is time for well-designed randomized controlled trials, powered for clinical endpoints such as mortality, readmission, and quality of life, to determine whether there are differences in the safety and effectiveness of these agents both for management of chronic HF and for episodes of acute decompensation.”

"Furosemide is the dominantly used loop diuretic in practice; however, if the potential advantages of torsemide over furosemide are proven in subsequent comparative effectiveness studies, this drug might become the preferred treatment of chronic heart failure,” Bikdeli added.

U.S. Pharmacist Social Connect