Incremental benefit of drug therapies for chronic heart failure with reduced ejection fraction: a network meta-analysis

Komajda, M., Böhm, M., Borer, J. S., Ford, I. , Tavazzi, L., Pannaux, M. and Swedberg, K. (2018) Incremental benefit of drug therapies for chronic heart failure with reduced ejection fraction: a network meta-analysis. European Journal of Heart Failure, 20(9), pp. 1315-1322. (doi: 10.1002/ejhf.1234) (PMID:29806165)

164888.pdf - Accepted Version



Aims: A network meta‐analysis (NMA) of all recommended drug groups for the treatment of heart failure with reduced ejection fraction (HFrEF), including their combinations, was performed to assess the relative efficacy and incremental benefit. Methods and results: A search was made in biomedical databases for randomized controlled trials published between 1987 and 2017 on angiotensin‐converting enzyme inhibitors (ACEIs), beta‐blockers (BBs), angiotensin receptor blockers (ARBs), mineralocorticoid receptor antagonists (MRAs), ivabradine (IVA), or angiotensin receptor–neprilysin inhibitors (ARNI). A total of 58 relevant trials were identified. The relative efficacy of each treatment group (or combination) in terms of all‐cause mortality, cardiovascular mortality, all‐cause hospitalizations and hospitalizations for heart failure, per patient‐year of follow‐up, were combined in a random‐effects Bayesian NMA. The pairwise comparison between each regimen and for each outcome was estimated. The NMA was dominated by 15 large‐scale trials with between 1984 and 18 898 patient‐years of follow‐up. Combinations of drug groups showed incremental benefits on outcomes over single groups. The most effective combinations were ARNI+BB + MRA and ACEI+BB + MRA + IVA, showing reductions in all‐cause mortality (vs. placebo) of 62% and 59%, respectively; hazard ratios were 0.38 [credible interval (CrI) 0.20–0.65] and 0.41 (CrI 0.21–0.70); and in all‐cause hospitalizations with reductions of 42% for both. These two combinations were also the most effective for the other outcomes studied. Conclusion: Our analysis shows that the incremental use of combinations of disease‐modifying therapies has resulted in the progressive improvement in mortality and hospitalization outcomes in HFrEF. Our findings support the current guideline recommendations.

Item Type:Articles
Additional Information:The study was supported by Les Laboratoires Servier (Suresnes, France).
Glasgow Author(s) Enlighten ID:Ford, Professor Ian
Authors: Komajda, M., Böhm, M., Borer, J. S., Ford, I., Tavazzi, L., Pannaux, M., and Swedberg, K.
Subjects:R Medicine > R Medicine (General)
College/School:College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre
Journal Name:European Journal of Heart Failure
ISSN (Online):1879-0844
Published Online:27 May 2018
Copyright Holders:Copyright © 2018 The Authors
First Published:First published in European Journal of Heart Failure 20(9): 1315-1322
Publisher Policy:Reproduced in accordance with the copyright policy of the publisher

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