Department of Cardiovascular Science at the University of Sheffield and Cardiology Department at Sheffield Teaching Hospitals NHS Trust, Sheffield, UK.
Eur J Heart Fail. 2014 Feb;16(2):143-50. doi: 10.1111/ejhf.31. Epub 2013 Dec 14.
Clinical trials have demonstrated morbidity and mortality benefits of mineralocorticoid receptor antagonists (MRAs) in patients with heart failure. These studies have used either spironolactone or eplerenone as the MRA. It is generally believed that these two agents have the same effects, and the data from studies using one drug could be extrapolated for the other. National and international guidelines do not generally discriminate between spironolactone and eplerenone, but strongly recommend using an MRA for patients with heart failure due to LV systolic dysfunction and post-infarct LV systolic dysfunction. There are no major clinical trials directly comparing the efficacy of these two drugs. This article aims to compare the pharmacokinetics and pharmacodynamics of spironolactone and eplerenone, and to analyse the available data for their cardiovascular indications and adverse effects. We have also addressed the role of special circumstances including co-morbidities, concomitant drug therapy, cost, and licensing restrictions in choosing an appropriate MRA for a particular patient, thus combining an evidence-based approach with personalized medicine.
临床试验已经证明了盐皮质激素受体拮抗剂（MRAs）在心力衰竭患者中的发病率和死亡率获益。这些研究使用螺内酯或依普利酮作为 MRA。一般认为这两种药物具有相同的作用，并且使用一种药物的研究数据可以外推到另一种药物。国家和国际指南通常不区分螺内酯和依普利酮，但强烈建议对因左心室收缩功能障碍和心肌梗死后左心室收缩功能障碍导致心力衰竭的患者使用 MRA。目前还没有直接比较这两种药物疗效的大型临床试验。本文旨在比较螺内酯和依普利酮的药代动力学和药效学，并分析其心血管适应证和不良反应的现有数据。我们还讨论了特殊情况（包括合并症、伴随药物治疗、成本和许可限制）在为特定患者选择合适的 MRA 中的作用，从而将循证方法与个体化医学相结合。
