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Inderal, Corgard superior to Lopressor in long QT syndrome
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Two beta-blockers, propranolol and nadolol, were associated with longer event-free survival as compared with a third beta-blocker, metoprolol, in patients with symptomatic long QT syndrome, according to study results recently published in the Journal of the American College of Cardiology.
Researchers also found that propranolol (Inderal, AstraZeneca) had a significantly better QTc shortening effect when compared with metoprolol (Lopressor, Novartis) and nadolol (Corgard, King Pharmaceuticals Inc.), especially in patients with prolonged QTc. In symptomatic patients (n=101), 15 had breakthrough cardiac events, all of which were syncopes. Researchers said QTc shortening appeared significantly less pronounced among those with breakthrough cardiac events.
Also, in symptomatic patients, those started on metoprolol were found to be at a significantly higher risk for breakthrough cardiac events compared with patients started on propranolol and nadolol after adjustment for genotype (OR=3.95; 95% CI, 1.2-13.1).
Besides propranolol having a significantly better QTc shortening effect compared with metoprolol and nadolol, researchers found propranolol and nadolol to be equally effective. However, in symptomatic patients, those started on metoprolol were found to be at a significantly higher risk for breakthrough cardiac events.
“Metoprolol should not be used for symptomatic [long QT syndrome type 1] and [long QT syndrome type 2] patients,” the researchers wrote.
Researchers examined electrocardiographic and clinical parameters of 382 patients with long QT syndrome. All patients were aged older than 1 year when initiated (median age, 14 years; 56% girls or women; 27% symptomatic). Patients were either initiated on propranolol (n=134), metoprolol (n=147), or nadolol (n=101). Researchers then documented symptoms before therapy and the first breakthrough cardiac event.
“This multicenter study on long QT syndrome patients receiving beta-blocker therapy has shown for the first time that propranolol and nadolol are significantly more effective than metoprolol in preventing [breakthrough cardiac events] in symptomatic patients. Also, propranolol was superior to both nadolol and metoprolol in terms of shortening the cardiac repolarization time, particularly in high-risk patients with markedly prolonged QTc,” the researchers said.
Disclosure: See the study for a full list of financial disclosures.
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