Carvedilol, metoprolol succinate similarly effective in patients with HF

The beta-blockers carvedilol and metoprolol succinate appear to be similarly effective in preventing mortality in patients with HF, according to new registry data.

Researchers investigated whether carvedilol is associated with improved survival in patients with HF as compared with metoprolol succinate. According to the study background, some experts have hypothesized that carvedilol might offer an additional benefit over other beta-blockers in patients with HF because it exhibits antioxidant activity and inhibits endothelin. The COMET trial found a 17% survival benefit for patients with HF taking carvedilol vs. those taking metoprolol, but that trial used metoprolol tartrate, which is not approved for HF, instead of metoprolol succinate, an extended-release form that is.

Using data from a Danish national HF registry linked with health care and administrative databases, Björn Pasternak, MD, PhD, and colleagues performed a cohort study of patients with incident HF with left ventricular ejection fraction ≤40% (mean age, 69.3 years; 71% men) who were receiving carvedilol (n=6,026) or metoprolol succinate (n=5,638).

The primary outcome was all-cause mortality and the secondary outcome was CV mortality. Median follow-up was 2.4 years.

During follow-up, the cumulative incidence of mortality was 18.3% for carvedilol users and 18.8% for metoprolol succinate users.

Pasternak, from the department of epidemiology research at Statens Serum Institut, Copenhagen, Denmark, and colleagues found that compared with metoprolol succinate users, the adjusted HR for all-cause mortality for carvedilol users was 0.99 (95% CI, 0.88-1.11), which corresponded to an absolute risk difference of –0.07 (95% CI, –0.84 to 0.77) deaths per 100 person-years.

The adjusted HR was similar when comparing only patients who achieved the recommended daily target dose of their medication (HR=0.97; 95% CI, 0.72-1.3). An analysis using propensity score matching produced similar findings (HR=0.97; 95% CI, 0.84-1.13).

For CV mortality, the adjusted HR was 1.05 (95% CI, 0.88-1.26), according to the findings.

The results were consistent across subgroup analyses, including by sex, age, levels of LVEF, NYHA classification and history of ischemic heart disease.

“Any difference between carvedilol and metoprolol succinate, if it exists, is unlikely to be clinically meaningful,” Pasternak and colleagues wrote. They noted that this study “lends support to current treatment recommendations, which do not explicitly support the use of one beta-blocker with proven mortality benefit in HF over the other and thereby regard the effectiveness of these drugs as equivalent.”

For more information:

Pasternak B. Abstract #2225. Presented at: the European Society of Cardiology Congress; Aug. 30-Sept. 3, 2014; Barcelona, Spain.

Pasternak B. JAMA Intern Med. 2014;174:1597-1604.

Disclosure: The researchers report no relevant financial disclosures.