Tolvaptan For Heart Failure: A Systematic Review

[Objective] To systematically review the efficacy and safety of tolvaptan for the patients with heart failure.[Methods] On the basis of the literature retrieval method according to the Cochrane Meta-analysis, such databases as Web of Science、The Cochrane Library、 PubMed、EMbase、CNK1、CBM、WanFang Data and VIP were searched electronically, from inception to October 2013, for relevant studies. At the same time, manual retrieval with tolvaptan and heart failure treatment related cardiovascular field at home and abroad. Two reviewers independently screened literature, extracted data, and assessed the methodological quality of the included studies according to the inclusion and exclusion criteria as well as the methods recommended by the Cochrane Collaboration. The mean difference (MD) and its 95% confidence interval (CI) said the measurement data statistical quantity, and the odds ratio (OR) or relative risk (RR) and 95% CI said the count data statistical quantity. The evaluation of index:the body weight, the serum sodium concentration, the dyspnea or pulmonary congestion, the peripheral edema, and the adverse events. And then, employ RevMan 5.2.3 software to perform Meta-analysis.[Results] This study included eight randomized controlled clinical trials involving a total of 4908 participants who were heart failure patients. The results of this Meta-analysis showed that tolvaptan was more effective than placebo in increasing the serum sodium concentration(MD=3.63,95%CI 3.32 to 3.94, P=0.000),in decreasing body weight(MD=-0.81,95%CI-0.92 to-0.70, P=0.000)and possibly in the improvement of dyspnea or pulmonary congestion(OR=1.34,95%CI 1.17 to 1.55, P=0.000). However, there was no significant difference in peripheral edema between tolvaptan and placebo possibly(OR=1.96,95% CI 0.88 to 4.37, P=0.100).On the other side, the tolvaptan group was lower than the placebo group significantly on the incidence of adverse events(OR=1.36,95%CI 1.15 to 1.61, P=0.000).[Conclusion] Based on the Meta-analysis, tolvaptan was more effective than placebo in increasing the serum sodium concentration, in decreasing body weight, and possibly in the improvement of dyspnea or pulmonary congestion. Tolvaptan can’t improve peripheral edema possibly. As tolvaptan was more than placebo in the incidence of adverse events (thirsty/dry, dehydration, frequent urination, dizziness, irritability, nausea, constipation, urinary pain, elevated uric acid, etc.), patients can tolerance the adverse events well. In a word, tolvaptan is effective for the patients with heart failure, and patients can tolerance the adverse events well.