CRD SUMMARY: This review found that eplerenone did not appear to be more effective in improving clinical outcomes for patients with left ventricular dysfunction (heart failure) compared with older aldosterone antagonists. The conclusion appears generally appropriate but was weakened by being based on indirect comparisons and may not be applicable to all patient groups.
QUESTION: In patients with left ventricular (LV) dysfunction, what is the relative efficacy of eplerenone and other aldosterone antagonists (AAs)? REVIEW SCOPE: Included studies compared eplerenone or other AAs with control (placebo, angiotensin-converting enzyme inhibitor, angiotensin-receptor blocker, or β-blocker) in patients > 18 years of age with symptomatic or asymptomatic LV dysfunction, had ≥ 8 weeks of follow-up, and reported ≥ 1 outcome of interest. Studies comparing AAs with each other were excluded. Outcomes were all-cause mortality, cardiovascular (CV) mortality, gynecomastia {per trial definition in individual studies}, and hyperkalemia {serum potassium > 5.5 mEq/L}. REVIEW METHODS: MEDLINE, EMBASE/Excerpta Medica, CINAHL, and Cochrane Central Register of Controlled Trials (all to Jul 2011); reference lists; and reviews were searched for randomized controlled trials (RCTs). 16 RCTs (n = 12 505, mean age 55 to 69 y, 54% to 87% men) met selection criteria. 4 RCTs included patients after acute myocardial infarction LV dysfunction, and 12 included patients with heart failure. Study drugs were spironolactone (10 RCTs), canrenone (3 RCTs), and eplerenone (3 RCTs). Risk for bias (Cochrane criteria) was low for 8 RCTs, intermediate for 7, and high for 1. MAIN RESULTS: Eplerenone and other AAs reduced all-cause mortality and CV mortality compared with no AA. Eplerenone increased risk for hyperkalemia, and other AAs increased risk for gynecomastia, compared with no AA. Based on an indirect comparison, other AAs reduced mortality more than eplerenone (P = 0.009). CONCLUSION: Based on an indirect comparison, eplerenone is not more effective at reducing mortality for adults with left ventricular dysfunction than other aldosterone antagonists.
This review found that eplerenone did not appear to be more effective in improving clinical outcomes for patients with left ventricular dysfunction (heart failure) compared with older aldosterone antagonists. The conclusion appears generally appropriate but was weakened by being based on indirect comparisons and may not be applicable to all patient groups.
