Torasemide versus furosemide in treatment of heart failure: A systematic review and meta-analysis of randomized controlled trials.

Nourin Ali Sherif, Mostafa Ebraheem Morra, Le Van Thanh, Ghadeer Gamal Elsayed, Aya Hesham Elkady, Abdelrahman Elshafay, Nguyen Dang Kien, Ahmed Al-Habbaa, Le Huu Nhat Minh, Mai Nhu Y, Thai Le Ba Nghia, Abdelrhman Tarek Mohammed, Peter Samuel Eid, Tarek Turk, Kenji Hirayama, Nguyen Tien Huy

Journal: Journal of evaluation in clinical practice 2021;26(3):842-851

PMID: 31436024

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Abstract

AIM

Diuretics are a cornerstone in treatment of heart failure (HF). Torasemide is a loop diuretic with a potential advantage over other diuretics. We aim to meta-analyse and compare the effect of torasemide with furosemide in HF patients.

METHODS

A comprehensive literature search using 12 databases including PubMed, Scopus, and Web of Science was performed. All randomized controlled trials (RCTs) comparing furosemide and torasemide in HF patients were included and meta-analysed. We assessed the risk of bias using Cochrane Collaboration's tool. The protocol was registered in PROSPERO (CRD42016046112).

RESULTS

Eighteen RCTs with 1598 patients were included. There was a significant difference between torasemide 20 mg and furosemide 40 mg in increasing the urine volume (standard difference of the mean (SDM) [95% confidence interval] = -0.78 [-1.52 to -0.053], P = .036). Torasemide 10 mg and 10 to 20 mg have a significant effect on potassium excretion in comparison with furosemide 25 to 40 mg (P = .018 and .023, respectively). In general, torasemide and furosemide have no significant difference in mortality, edema improvement, weight loss, heart rate, and reducing systolic/diastolic blood pressure. However, oral torasemide has a significant lower hospital stay P < .001 and superior effect in improving ejection fraction P = .029.

CONCLUSION

Although not all results are statistically significant, torasemide has potential advantages on multiple aspects of HF management when compared with furosemide. More studies are needed to clarify these effects.

Address: Faculty of Medicine, Mansoura University, Mansoura, Egypt.; Online Research Club, Nagasaki, Japan.; Faculty of Medicine, Al-Azhar University, Cairo, Egypt.; Online Research Club, Nagasaki, Japan.; Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.; Online Research Club, Nagasaki, Japan.; Faculty of Medicine, Benha University, Benha, Egypt.; Online Research Club, Nagasaki, Japan.; Faculty of Medicine, Menoufia University, Shebin El-Kom, Egypt.; Online Research Club, Nagasaki, Japan.; Faculty of Medicine, Al-Azhar University, Cairo, Egypt.; Department of Obstetrics and Gynecology, Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam.; Cardiology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.; Online Research Club, Nagasaki, Japan.; Faculty of Medicine, Vo Truong Toan University, Hau Giang, Vietnam.; Online Research Club, Nagasaki, Japan.; Faculty of Medicine, Ain Shams University, Cairo, Egypt.; Faculty of Medicine, Damascus University, Damascus, Syria.; Department of Immunogenetics, Institute of Tropical Medicine (NEKKEN), Leading Graduate School Program, and Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan.; Evidence Based Medicine Research Group, Ton Duc Thang University, Ho Chi Minh City, Vietnam.; Faculty of Applied Sciences, Ton Duc Thang University, Ho Chi Minh City, Vietnam.

DOI: 10.1111/jep.13261