PDF(Pubmed)
Abstract：
UNASSIGNED: Several conflicting reviews have concluded that the use of loop diuretics is associated with poorer clinical and safety outcomes. Therefore, this study aimed to investigate the efficacy and safety of tolvaptan as an adjunct to conventional diuretic therapy in patients with acute heart failure (AHF).
UNASSIGNED: A comprehensive search was conducted on PubMed, Embase, ProQuest, EBSCO, and Cochrane Library until 24 May 2023 to identify randomized controlled trials that compared the effects of tolvaptan with conventional therapy and placebo in patients with AHF. The quality assessment of the included trials was conducted using the Cochrane risk of bias. A network meta-analysis (NMA) was conducted to examine the dosage effect of tolvaptan.
UNASSIGNED: A total of 17 studies with 18 reports, involving 10,039 patients, were selected. The tolvaptan add-on therapy significantly alleviated dyspnea [24 h: RR 1.16 (1.04, 1.29), 48 h: RR 1.18 (1.04, 1.33)], reduced body weight within 48 h [Asian group, MD -0.93 (-1.48, -0.38); non-Asian group, MD -2.76 (-2.88, -2.65)], reduced edema [RR 1.08 (1.02, 1.15)], increased serum sodium [non-Asian group, MD 3.40 (3.02, 3.78)], and resulted in a change in serum creatinine [MD -0.10 (-0.18, -0.01)]. No significant differences were observed in mortality and rehospitalization. The NMA suggested that an intermediate dosage (15 mg/day) might offer the best efficacy in reducing dyspnea within 24 h, reducing edema, increasing serum sodium, and lowering the incidence of worsening renal function (WRF).
UNASSIGNED: In conclusion, the meta-analysis showed that tolvaptan contributed to the short-term alleviation of congestive symptoms, elevated sodium levels, and a lower incidence of WRF. However, no significant benefits were observed in long-term symptoms, rehospitalization rates, and mortality. An intermediate dosage of tolvaptan might be considered the optimal choice for various clinical outcomes.
UNASSIGNED: https://www.crd.york.ac.uk/, PROSPERO (CRD42023420288).
UNASSIGNED: A comprehensive search was conducted on PubMed, Embase, ProQuest, EBSCO, and Cochrane Library until 24 May 2023 to identify randomized controlled trials that compared the effects of tolvaptan with conventional therapy and placebo in patients with AHF. The quality assessment of the included trials was conducted using the Cochrane risk of bias. A network meta-analysis (NMA) was conducted to examine the dosage effect of tolvaptan.
UNASSIGNED: A total of 17 studies with 18 reports, involving 10,039 patients, were selected. The tolvaptan add-on therapy significantly alleviated dyspnea [24 h: RR 1.16 (1.04, 1.29), 48 h: RR 1.18 (1.04, 1.33)], reduced body weight within 48 h [Asian group, MD -0.93 (-1.48, -0.38); non-Asian group, MD -2.76 (-2.88, -2.65)], reduced edema [RR 1.08 (1.02, 1.15)], increased serum sodium [non-Asian group, MD 3.40 (3.02, 3.78)], and resulted in a change in serum creatinine [MD -0.10 (-0.18, -0.01)]. No significant differences were observed in mortality and rehospitalization. The NMA suggested that an intermediate dosage (15 mg/day) might offer the best efficacy in reducing dyspnea within 24 h, reducing edema, increasing serum sodium, and lowering the incidence of worsening renal function (WRF).
UNASSIGNED: In conclusion, the meta-analysis showed that tolvaptan contributed to the short-term alleviation of congestive symptoms, elevated sodium levels, and a lower incidence of WRF. However, no significant benefits were observed in long-term symptoms, rehospitalization rates, and mortality. An intermediate dosage of tolvaptan might be considered the optimal choice for various clinical outcomes.
UNASSIGNED: https://www.crd.york.ac.uk/, PROSPERO (CRD42023420288).
摘要：
■几个相互矛盾的综述得出结论，使用环利尿剂与较差的临床和安全性结果相关。因此,本研究旨在探讨托伐普坦辅助常规利尿剂治疗急性心力衰竭(AHF)患者的疗效和安全性.
■在PubMed上进行了全面搜索，Embase,ProQuest,EBSCO,和Cochrane图书馆直到2023年5月24日，以确定随机对照试验，比较托伐普坦与常规治疗和安慰剂对AHF患者的影响。纳入试验的质量评估采用Cochrane偏倚风险进行。进行了网络荟萃分析（NMA）以检查托伐普坦的剂量效应。
■共17项研究，18份报告，涉及10039名患者,被选中。托伐普坦附加治疗可显着缓解呼吸困难[24h：RR1.16（1.04，1.29），48小时：RR1.18（1.04，1.33）]，48小时内体重减轻[亚洲组，MD-0.93（-1.48，-0.38）；非亚洲组，MD-2.76(-2.88,-2.65)],水肿减少[RR1.08(1.02,1.15)]，血清钠升高[非亚洲人群，MD3.40(3.02,3.78)],并导致血清肌酐变化[MD-0.10（-0.18，-0.01）]。在死亡率和再住院方面没有观察到显著差异。NMA建议，中间剂量（15毫克/天）可能在24小时内减少呼吸困难方面提供最佳疗效。减少水肿，增加血清钠，降低肾功能恶化（WRF）的发生率。
■总而言之，荟萃分析显示托伐普坦有助于短期缓解充血性症状，钠水平升高，WRF的发生率较低。然而,在长期症状中没有观察到显著的益处，再住院率，和死亡率。托伐普坦的中等剂量可能被认为是各种临床结果的最佳选择。
■https://www.crd.约克。AC.英国/,PROSPERO（CRD42023420288）。
■在PubMed上进行了全面搜索，Embase,ProQuest,EBSCO,和Cochrane图书馆直到2023年5月24日，以确定随机对照试验，比较托伐普坦与常规治疗和安慰剂对AHF患者的影响。纳入试验的质量评估采用Cochrane偏倚风险进行。进行了网络荟萃分析（NMA）以检查托伐普坦的剂量效应。
■共17项研究，18份报告，涉及10039名患者,被选中。托伐普坦附加治疗可显着缓解呼吸困难[24h：RR1.16（1.04，1.29），48小时：RR1.18（1.04，1.33）]，48小时内体重减轻[亚洲组，MD-0.93（-1.48，-0.38）；非亚洲组，MD-2.76(-2.88,-2.65)],水肿减少[RR1.08(1.02,1.15)]，血清钠升高[非亚洲人群，MD3.40(3.02,3.78)],并导致血清肌酐变化[MD-0.10（-0.18，-0.01）]。在死亡率和再住院方面没有观察到显著差异。NMA建议，中间剂量（15毫克/天）可能在24小时内减少呼吸困难方面提供最佳疗效。减少水肿，增加血清钠，降低肾功能恶化（WRF）的发生率。
■总而言之，荟萃分析显示托伐普坦有助于短期缓解充血性症状，钠水平升高，WRF的发生率较低。然而,在长期症状中没有观察到显著的益处，再住院率，和死亡率。托伐普坦的中等剂量可能被认为是各种临床结果的最佳选择。
■https://www.crd.约克。AC.英国/,PROSPERO（CRD42023420288）。
