Comparative effectiveness of torasemide versus furosemide in symptomatic therapy in heart failure patients: Preliminary results from the randomized TORNADO trial
Abstract
Background: Recent reports suggest that torasemide might be more beneficial than furosemide in
patients with symptomatic heart failure (HF). The aim was to compare the effects of torasemide and
furosemide on clinical outcomes in HF patients.
Methods: This study pilot consisted of data from the ongoing multicenter, randomized, unblinded
endpoint phase IV TORNADO (NCT01942109) study. HF patients in New York Heart Association
(NYHA) II–IV class with a stable dose of furosemide were randomized to treatment with equipotential
dose of torasemide (4:1) or continuation of unchanged dose of furosemide. On enrollment and
control visit (3 months after enrollment) clinical examination, 6-minute walk test (6MWT) and
assessment of fluid retention by ZOE Fluid Status Monitor were performed. The primary endpoint was
a composite of improvement of NYHA class, improvement of at least 50 m during 6MWT and decrease
in fluid retention of at least 0.5 W after 3-months follow-up.
Results: The study group included 40 patients (median age 66 years; 77.5% male). During follow-up
7 patients were hospitalized for HF worsening (3 in torasemide and 4 in furosemide-treated patients).
The primary endpoint reached 15 (94%) and 14 (58%) patients on torasemide and furosemide, respectively
(p = 0.03).
Conclusions: In HF patients treated with torasemide fluid overload and symptoms improved more than
in the furosemide group. This positive effect occurred already within 3-month observation.
Keywords: heart failurehospitalizationloop diureticsprognosissymptoms
References
- Ponikowski P, Voors A, Anker S, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2016; 37(27): 2129–2200.
- Dyrla W, Kuch M. Torasemide and furosemide – similarities and differences. Medycyna Faktów. 2018; 11(4): 322–327.
- Palazzuoli A, Ruocco G, Ronco C, et al. Loop diuretics in acute heart failure: beyond the decongestive relief for the kidney. Crit Care. 2015; 19: 296.
- Uchida T, Yamanaga K, Nishikawa M, et al. Anti-aldosteronergic effect of torasemide. Eur J Pharmacol. 1991; 205(2): 145–150.
- Goodfriend TL, Ball DL, Oelkers W, et al. Torsemide inhibits aldosterone secretion in vitro. Life Sci. 1998; 63(3): PL45–PL50.
- Ballester MR, Roig E, Gich I, et al. Randomized, open-label, blinded-endpoint, crossover, single-dose study to compare the pharmacodynamics of torasemide-PR 10 mg, torasemide-IR 10 mg, and furosemide-IR 40 mg, in patients with chronic heart failure. Drug Des Devel Ther. 2015; 9: 4291–4302.
- DiNicolantonio JJ. Should torsemide be the loop diuretic of choice in systolic heart failure? Future Cardiol. 2012; 8(5): 707–728.
- López B, Querejeta R, González A, et al. Effects of loop diuretics on myocardial fibrosis and collagen type I turnover in chronic heart failure. J Am Coll Cardiol. 2004; 43(11): 2028–2035.
- Mentz RJ, Buggey J, Fiuzat M, et al. Torsemide versus furosemide in heart failure patients: insights from Duke University Hospital. J Cardiovasc Pharmacol. 2015; 65(5): 438–443.
- Buggey J, Mentz RJ, Pitt B, et al. A reappraisal of loop diuretic choice in heart failure patients. Am Heart J. 2015; 169(3): 323–333.
- Mamcarz A, Filipiak KJJ, Drożdż J, et al. [Loop diuretics: old and new ones--which one to choose in clinical practice? Experts' Group Consensus endorsed by the Polish Cardiac Society Working Group on Cardiovascular Pharmacotherapy and Working Group on Heart Failure]. Kardiol Pol. 2015; 73(3): 225–232.
- Harada K, Izawa H, Nishizawa T, et al. Beneficial effects of torasemide on systolic wall stress and sympathetic nervous activity in asymptomatic or mildly symptomatic patients with heart failure: comparison with azosemide. J Cardiovasc Pharmacol. 2009; 53(6): 468–473.
- Balsam P, Ozierański K, Tymińska A, et al. The impact of torasemide on haemodynamic and neurohormonal stress, and cardiac remodelling in heart failure - TORNADO: a study protocol for a randomized controlled trial. Trials. 2017; 18(1): 36.
- Opolski G, Ozierański K, Lelonek M, et al. Adherence to the guidelines on the management of systolic heart failure in ambulatory care in Poland. Data from the international QUALIFY survey. Pol Arch Intern Med. 2017; 127(10): 657–665.
- Stroupe KT, Forthofer MM, Brater DC, et al. Healthcare costs of patients with heart failure treated with torasemide or furosemide. Pharmacoeconomics. 2000; 17(5): 429–440.
- Young M, Plosker GL. Torasemide: a pharmacoeconomic review of its use in chronic heart failure. Pharmacoeconomics. 2001; 19(6): 679–703.
- Spannheimer A, Goertz A, Dreckmann-Behrendt B. Comparison of therapies with torasemide or furosemide in patients with congestive heart failure from a pharmacoeconomic viewpoint. Int J Clin Pract. 1998; 52(7): 467–471.
- Ozierański K, Balsam P, Kapłon-Cieślicka A, et al. Comparative analysis of long-term outcomes of torasemide and furosemide in heart failure patients in heart failure registries of the European Society of Cardiology. Cardiovasc Drugs Ther. 2019; 33(1): 77–86.
- Cosín J, Díez J. TORIC investigators. Torasemide in chronic heart failure: results of the TORIC study. Eur J Heart Fail. 2002; 4(4): 507–513.
- Kido K, Shimizu M, Hashiguchi M. Comparing torsemide versus furosemide in patients with heart failure: A meta-analysis. J Am Pharm Assoc (2003). 2019; 59(3): 432–438.
- Mentz RJ, Hasselblad V, DeVore AD, et al. Torsemide Versus Furosemide in Patients With Acute Heart Failure (from the ASCEND-HF Trial). Am J Cardiol. 2016; 117(3): 404–411.
- Vargo DL, Kramer WG, Black PK, et al. Bioavailability, pharmacokinetics, and pharmacodynamics of torsemide and furosemide in patients with congestive heart failure. Clin Pharmacol Ther. 1995; 57(6): 601–609.
- Kasama S, Toyama T, Hatori T, et al. Effects of torasemide on cardiac sympathetic nerve activity and left ventricular remodelling in patients with congestive heart failure. Heart. 2006; 92(10): 1434–1440.
- Yamato M, Sasaki T, Honda K, et al. Effects of torasemide on left ventricular function and neurohumoral factors in patients with chronic heart failure. Circ J. 2003; 67(5): 384–390.
- Broekhuysen J, Deger F, Douchamps J, et al. Torasemide, a new potent diuretic. Double-blind comparison with furosemide. Eur J Clin Pharmacol. 1986; 31 Suppl: 29–34.
- ToRsemide comparison With furosemide FORManagement of Heart Failure (TRANSFORM-HF ) ClinicalTrials.gov Identifier: NCT03296813.
