Wang Yuhui, Gao Yu, Feng Jun, Hou Linlin, Luo Chunmiao, Zhang Zhipeng
Hefei Hospital Affiliated to Anhui Medical University, The Second People's Hospital of Hefei, Hefei, People's Republic of China.
The Fifth Clinical College of Anhui Medical University, Hefei, People's Republic of China.
Cardiovasc Drugs Ther. 2024 Dec;38(6):1245-1257. doi: 10.1007/s10557-023-07473-w. Epub 2023 Jun 7.
To evaluate the efficacy and safety of patiromer, a novel potassium binder, in reducing the risk of hyperkalemia in patients with heart failure and optimizing their RAASi therapy.
Systematic review and meta-analyses.
The authors conducted a systematic search in Pubmed, Embase, Web of Science, and Cochrane Library for randomized controlled trials investigating the efficacy and safety of patiromer in heart failure patients from inception to 31 January 2023 and updated on 25 March 2023. The primary outcome was the association between the reduction of hyperkalemia and patiromer compared with placebo, and the secondary outcome was the association between optimization of RAASi therapy and patiromer.
A total of four randomized controlled trials (n = 1163) were included in the study. Patiromer was able to reduce the risk of hyperkalemia in heart failure patients by 44% (RR 0.56, 95% CI 0.36 to 0.87; I = 61.9%), improve tolerance to target doses of MRA in patients with heart failure (RR 1.15, 95% CI 1.02 to 1.30; I = 49.4%), and decrease the proportion of all-cause discontinuation of RAASi (RR 0.49, 95% CI 0.25 to 0.98; I = 48.4%). However, patiromer therapy was associated with an increased risk of hypokalemia (RR 1.51, 95% CI 1.07 to 2.12; I = 0%), while no other statistically significant adverse events were observed.
Patiromer appears to have a considerable effect on reducing the incidence of hyperkalemia in heart failure patients and on optimizing the therapy of RAASi in those patients.
评估新型钾离子结合剂帕替罗姆在降低心力衰竭患者高钾血症风险及优化其肾素-血管紧张素-醛固酮系统抑制剂（RAASi）治疗方面的疗效和安全性。
系统评价和荟萃分析。
作者在PubMed、Embase、科学网和考克兰图书馆进行了系统检索，以查找从研究起始至2023年1月31日并于2023年3月25日更新的、调查帕替罗姆在心力衰竭患者中疗效和安全性的随机对照试验。主要结局是与安慰剂相比，帕替罗姆降低高钾血症的相关性，次要结局是帕替罗姆与优化RAASi治疗的相关性。
该研究共纳入四项随机对照试验（n = 1163）。帕替罗姆能够将心力衰竭患者高钾血症风险降低44%（风险比0.56，95%置信区间0.36至0.87；I² = 61.9%），提高心力衰竭患者对目标剂量盐皮质激素受体拮抗剂（MRA）的耐受性（风险比1.15，95%置信区间1.02至1.30；I² = 49.4%），并降低RAASi全因停药比例（风险比0.49，95%置信区间0.25至0.98；I² = 48.4%）。然而，帕替罗姆治疗与低钾血症风险增加相关（风险比1.51，95%置信区间1.07至2.12；I² = 0%），未观察到其他具有统计学意义的不良事件。
帕替罗姆似乎在降低心力衰竭患者高钾血症发生率及优化这些患者的RAASi治疗方面有显著效果。
