The Pharmaceutical Journal
Vol 270 No 7244 p506
12 April 2003
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Aldosterone blocker improves survival in heart failure after MIAdding eplerenone (Inspra), a selective aldosterone blocker, to optimal treatment in patients with left ventricular dysfunction after a myocardial infarction reduces deaths due to cardiovascular events, according to data presented at the American College of Cardiology meeting in Chicago last week. The study, which used the acronym EPHESUS, randomised 6,642 patients to receive either eplerenone 25–50mg or placebo daily. After an average of 16 months of follow-up, there were 478 deaths in the eplerenone group and 554 in the placebo group (relative risk 0.85, 95 per cent confidence interval 0.75–0.96, P=0.008). Of these deaths, 407 in the active group and 483 in the controls were attributed to cardiovascular causes (relative risk 0.83, CI 0.72–0.94, P=0.005). There was also a 15 per cent reduction in the risk of being admitted to hospital for heart failure in the eplerenone group and 23 per cent fewer episodes of hospital admission for heart failure. Dr Bertram Pitt, University of Michigan, Ann Arbor, lead investigator for the EPHESUS trial, said at the ACC conference that eplerenone was beneficial in patients who were already receiving optimal therapy, including angiotensin-converting-enzyme inhibitors, beta-blockers and lipid-lowering agents. This trial shows that on top of what we currently have we can do better, he said. He added that the lack of a spironolactone control arm in the study was due to there having been no data to show that spironolactone was effective post-MI at the time the trial was designed. The trial was published last week in The New England Journal of Medicine (2003; 348:1309). |
The Pharmaceutical Journal attended the American College of Cardiology congress courtesy of Merck/Schering-Plough Pharmaceuticals |
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