Prediktor Respons Tolvaptan Sebagai Strategi Optimalisasi Terapi pada Pasien Gagal Jantung: Kajian Naratif
Abstract
Gagal jantung (GJ) merupakan kondisi tahap akhir dari semua penyakit jantung dan dikaitkan dengan mortalitas, morbiditas, dan pengeluaran kesehatan yang signifikan. Tolvaptan, antagonis reseptor V2, telah digunakan di berbagai negara sebagai terapi tambahan pada terapi diuretik untuk GJ. Walaupun tolvaptan telah terbukti efektif dan aman digunakan, masih terdapat beberapa pasien yang tidak merespons tolvaptan dengan baik. Terdapat indikasi bahwa efek optimal tolvaptan dapat dicapai oleh populasi yang spesifik sehingga identifikasi responder dan prediktor respons tolvaptan menjadi penting dalam mengembangkan rencana pengobatan individu. Tujuan kajian naratif ini adalah memberikan ulasan mengenai efektivitas tambahan tolvaptan serta prediktor-prediktor respons yang dapat digunakan sebagai strategi dalam optimalisasi terapi GJ. Pencarian artikel dilakukan melalui PubMed, Google Scholar, dan Scopus dengan kata kunci predictors, heart failure, dan tolvaptan. Prediktor status respons yang ditemukan dalam penelitian, yaitu osmolalitas urin, U-AQP2/PAVP, usia, kreatinin serum, BUN, BUN/Cr, UUN/BUN, UNa/UCr, BNP, AVP/PAC, CKD dan HFpEF, serta berbagai parameter ekokardiografik. Variasi temuan prediktor dapat disebabkan oleh adanya perbedaan definisi respons dan karakteristik pasien, serta jenis variabel yang dianalisis. Beberapa prediktor yang ditemukan sulit untuk diimplementasikan di beberapa negara dengan fasilitas rumah sakit dan cakupan asuransi kesehatan yang belum memadai. Pada akhirnya, penggunaan prediktor respons diharapkan dapat membantu tenaga kesehatan dalam mempertimbangkan risiko-manfaat suatu terapi individu pada pasien GJ.
Kata kunci: Gagal jantung, prediktor, respons, tolvaptan
Predictors of Tolvaptan Response as a Therapy Optimization Strategy in Heart Failure Patients: A Narrative Review
Abstract
Heart failure (HF) is an end-stage condition of all heart disease and is associated with significant mortality, morbidity, and health expenses. Tolvaptan, a V2 receptor antagonist, is being used in many countries as an adjunct to the diuretic therapy of HF. Although it has been proven effective and safe, some patients do not respond well to the medication. Since there are indications that a specific population can achieve this therapy’s optimal effect, it is essential to identify responders and predictors to develop individual treatment plans. Therefore, this study provides an overview of the effect of tolvaptan and predictors of response that can be used as a strategy in optimizing the treatment of HF. The article searching process was conducted through PubMed, Google Scholar, and Scopus, including predictors, heart failure, and tolvaptan. The predictors identified in the study were urine osmolality, U-AQP2/PAVP, age, serum creatinine, BUN, BUN/Cr, UUN/BUN, UNa/UCr, BNP, AVP/PAC, CKD, HFpEF, and echocardiographic parameters. The variation in results is caused by differences in response definition, patient characteristics, and the types of variables analyzed. Implementing some of these predictors in countries with inadequate hospital facilities and health insurance coverage is complicated. Therefore, the use of response predictors, at any rate, is expected to assist health professionals in considering the risks and benefits of HF therapy.
Keywords: Heart failure, predictor, response, tolvaptan
Keywords
Full Text:
PDF (Bahasa Indonesia)References
Hasenfuss G, Mann DL. Braunwald’s heart disease. Philadelphia: Elsevier; 2019.
Lippi G, Sanchis-Gomar F. Global epidemiology and future trends of heart failure. AME Med J. 2020;5(June):15. doi: 10.21037/amj.2020.03.03
Reyes EB, Ha JW, Firdaus I, Ghazi AM, Phrommintikul A, Sim D, et al. Heart failure across Asia: Same healthcare burden but differences in organization of care. Int J Cardiol. 2016;223(15):163–7. doi: 10.1016/j.ijcard.2016.07.256
MacDonald MR, Tay WT, Teng THK, Anand I, Ling LH, Yap J, et al. Regional variation of mortality in heart failure with reduced and preserved ejection fraction across Asia: Outcomes in the ASIAN-HF registry. J Am Heart Assoc. 2020;9(5):e014512. doi: 10.1161/JAHA.119.012199
Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016;37(27):2129–200. doi: 10.1093/eurheartj/ehw128
Felker GM, Lee KL, Bull DA, Redfield MM, Stevenson LW, Goldsmith SR, et al. Diuretic strategies in patients with acute decompensated heart failure. N Engl J Med. 2011;364(9):797–805. doi: 10.1056/NEJMoa1005419
Damman K, Kjekshus J, Wikstrand J, Cleland JG, Komajda M, Wedel H, et al. Loop diuretics, renal function and clinical outcome in patients with heart failure and reduced ejection fraction. Eur J Heart Fail. 2016;18(3):328–36. doi: 10.1002/ejhf.462
Verbrugge FH, Grodin JL, Mullens W, Taylor DO, Starling RC, Tang WHW. Transient hyponatremia during hospitalization for acute heart failure. Am J Med. 2016;129(6):620–7. doi: 10.1016/j.amjmed.2016.01.016
Verbrugge FH, Steels P, Grieten L, Nijst P, Tang WHW, Mullens W. Hyponatremia in acute decompensated heart failure: Depletion versus dilution. J Am Coll Cardiol. 2015;65(5):480–92. doi: 10.1016/j.jacc.2014.12.010
Konishi M, Haraguchi G, Ohigashi H, Sasaoka T, Yoshikawa S, Inagaki H, et al. Progression of hyponatremia is associated with increased cardiac mortality in patients hospitalized for acute decompensated heart failure. J Card Fail. 2012;18(8):620–5. doi: 10.1016/j.cardfail.2012.06.415
Saepudin S, Ball PA, Morrissey H. Hyponatremia during hospitalization and in-hospital mortality in patients hospitalized from heart failure. BMC Cardiovasc Disord. 2015;15:88. doi: 10.1186/s12872-015-0082-5
Felker GM, Ellison DH, Mullens W, Cox ZL, Testani JM. Diuretic therapy for patients with heart failure: JACC State-of-the-Art Review. J Am Coll Cardiol. 2020;75(10):1178–95. doi: 10.1016/j.jacc.2019.12.059
Kiernan MS, Stevens SR, Tang WHW, Butler J, Anstrom KJ, Birati EY, et al. Determinants of diuretic responsiveness and associated outcomes during acute heart failure hospitalization: An analysis from the NHLBI Heart Failure Network Clinical Trials. J Card Fail. 2018;24(7):428–38. doi: 10.1016/j.cardfail.2018.02.002
Kitada S, Kikuchi S, Sonoda H, Yoshida A, Ohte N. Elevation of arginine vasopressin levels following loop diuretic therapy as a prognostic indicator in heart failure. J Int Med Res. 2016;44(6):1430–42. doi: 10.1177/0300060516663779
Uojima H, Hidaka H, Tanaka Y, Wada N, Kubota K, Nakazawa T, et al. Furosemide dose changes associated with furosemide/tolvaptan combination therapy in patients with cirrhosis. Dig Dis. 2020;38(1):38–45. doi: 10.1159/000501267
Wasilewski MA, Myers V, Recchia F, Feldman A, Tilley D. Arginine vasopressin receptor signaling and functional outcomes in heart failure. Cell Signal. 2016;28(3):224–33. doi: 10.1016/j.cellsig.2015.07.021
Siswanto BB, Hersunarti N, Rachmawan YP, Irnizarifka, Putri VK, Dewi TI. Konsensus tatalaksana cairan pada gagal jantung. Perhimpunan Dokter Spesialis Kardiovaskular Indonesia; 2020.
Tsutsui H, Isobe M, Ito H, Ito H, Okumura K, Ono M, et al. JCS 2017/JHFS 2017 Guideline on diagnosis and treatment of acute and chronic heart failure-digest version. Circ J. 2019;83(10):2084–184. doi: 10.1253/circj.CJ-19-0342
Konstam MA, Kiernan M, Chandler A, Dhingra R, Mody FV, Eisen H, et al. Short-term effects of tolvaptan in patients with acute heart failure and volume overload. J Am Coll Cardiol. 2017;69(11):1409–19. doi: 10.1016/j.jacc.2016.12.035
Shanmugam E, Doss CRMP, George M, Jena A, Rajaram M, Ramaraj B, et al. Effect of tolvaptan on acute heart failure with hyponatremia—A randomized, double blind, controlled clinical trial. Indian Heart J. 2016;68(1):S15–21. doi: 10.1016/j.ihj.2015.07.006
Jujo K, Saito K, Ishida I, Furuki Y, Kim A, Suzuki Y, et al. Randomized pilot trial comparing tolvaptan with furosemide on renal and neurohumoral effects in acute heart failure. ESC Heart Fail. 2016;3(3):177–88. doi: 10.1002/ehf2.12088
Nakano Y, Mizuno T, Niwa T, Mukai K, Wakabayashi H, Watanabe A, et al. Impact of continuous administration of tolvaptan on preventing medium-term worsening renal function and long-term adverse events in heart failure patients with chronic kidney disease. Int Heart J. 2018;59(1):105–11. doi: 10.1536/ihj.16-625
Uemura Y, Shibata R, Takemoto K, Uchikawa T, Koyasu M, Ishikawa S, et al. Safety and efficacy of long-term use of tolvaptan in patients with heart failure and chronic kidney disease. Circ J. 2017;81(11):1736–8. doi: 10.1253/circj.CJ-17-0554
Kinugawa K, Sato N, Inomata T, Yasuda M, Shimakawa T, Fukuta Y. Real-world effectiveness and tolerability of tolvaptan in patients with heart failure- final results of the Samsca Post-Marketing Surveillance in Heart Failure (SMILE) Study. Circ J. 2019;83(7):1520–7. doi: 10.1253/circj.CJ-19-0158
Hauptman PJ, Burnett J, Gheorghiade M, Grinfeld L, Konstam MA, Kostic D, et al. Clinical course of patients with hyponatremia and decompensated systolic heart failure and the effect of vasopressin receptor antagonism with tolvaptan. J Card Fail. 2013;19(6):390–7. doi: 10.1016/j.cardfail.2013.04.001
Vinod P, Krishnappa V, Chauvin AM, Khare A, Raina R. Cardiorenal syndrome: Role of arginine vasopressin and vaptans in heart failure. Cardiol Res. 2017;8(3):87–95. doi: 10.14740/cr553w
Verbalis JG, Goldsmith SR, Greenberg A, Korzelius C, Schrier RW, Sterns RH, et al. Diagnosis, evaluation, and treatment of hyponatremia: Expert panel recommendations. Am J Med. 2013;126(10 Suppl 1):S1–42. doi: 10.1016/j.amjmed.2013.07.006
Imamura T, Kinugawa K. Urine aquaporin-2: A promising marker of response to the arginine vasopressin type-2 antagonist, tolvaptan in patients with congestive heart failure. Int J Mol Sci. 2016;17(1):105. doi: 10.3390/ijms17010105
Kadota M, Ise T, Yagi S, Iwase T, Akaike M, Ueno R, et al. Response prediction and influence of tolvaptan in chronic heart failure patients considering the interaction of the renin-angiotensin-aldosterone system and arginine vasopressin. Int Heart J. 2016;57(4):461–5. doi: 10.1536/ihj.15-491
Kodaka K, Okuma EK, Arai S, Nagura M, Tamura Y, et al. Urinary exosomal aquaporin-2 expression and the efficacy of tolvaptan in advanced CKD patients with congestive heart failure-An interim report. J Clin Exp Nephrol. 2018;3:6. doi: 10.21767/2472-5056.100057
Matsue Y, Suzuki M, Torii S, Yamaguchi S, Fukamizu S, Ono Y, et al. Clinical effectiveness of tolvaptan in patients with acute heart failure and renal dysfunction. J Card Fail. 2016;22(6):423–32. doi: 10.1016/j.cardfail.2016.02.007
Imamura T, Kinugawa K, Shiga T, Kato N, Muraoka H, Minatsuki S, et al. Novel criteria of urine osmolality effectively predict response to tolvaptan in decompensated heart failure patients—association between non-responders and chronic kidney disease. Circ J. 2013;77(2):397–404. doi: 10.1253/circj.cj-12-0971
Imamura T, Kinugawa K, Fujino T, Inaba T, Maki H, Hatano M, et al. Increased urine aquaporin-2 relative to plasma arginine vasopressin is a novel marker of response to tolvaptan in patients with decompensated heart failure. Circ J. 2014;78(9):2240–9. doi: 10.1253/circj.cj-14-0244
Nakada Y, Okayama S, Nakano T, Ueda T, Onoue K, Takeda Y, et al. Echocardiographic characteristics of patients with acute heart failure requiring tolvaptan: A retrospective study. Cardiovasc Ultrasound. 2015;13:27. doi: 10.1186/s12947-015-0022-7
Okayama D, Suzuki T, Shiga T, Minami Y, Tsuruoka S, Hagiwara N. Blood urea nitrogen/creatinine ratio and response to tolvaptan in patients with decompensated heart failure: A retrospective analysis. Am J Cardiovasc Drugs. 2015;15(4):289–93.doi: 10.1007/s40256-015-0121-8
Shimizu K, Doi K, Imamura T, Noiri E, Yahagi N, Nangaku M, et al. Ratio of urine and blood urea nitrogen concentration predicts the response of tolvaptan in congestive heart failure. Nephrology (Carlton). 2015;20(6):405–12. doi: 10.1111/nep.12406
Sato Y, Dohi K, Watanabe K, Tanimura M, Takeuchi T, Sugiura E, et al. Combination of urinary sodium/creatinine ratio and plasma brain natriuretic peptide level predicts successful tolvaptan therapy in patients with heart failure and volume overload. Int Heart J. 2016;57(2):211–9. doi: 10.1536/ihj.15-330
Ikeda S, Ohshima K, Miyazaki S, Kadota H, Shimizu H, Ogimoto A, et al. Impact of chronic kidney disease on the diuretic response of tolvaptan in acute decompensated heart failure. ESC Heart Fail. 2017;4(4):614–22. doi: 10.1002/ehf2.12190
Nonin S, Iwata S, Ito A, Tamura S, Kitada R, Kawai Y, et al. Right ventricular enlargement predicts responsiveness to tolvaptan in congestive heart failure patients with reduced ejection fraction. Int J Cardiol Heart Vasc. 2018;21:69–73. doi: 10.1016/j.ijcha.2018.09.008
Kogure T, Jujo K, Hamada K, Saito K, Hagiwara N. Good response to tolvaptan shortens hospitalization in patients with congestive heart failure. Heart Vessels. 2018;33(4):374–83. doi: 10.1007/s00380-017-1072-6
Felker GM, Mentz RJ, Cole RT, Adams KF, Egnaczyk GF, Fiuzat M, et al. Efficacy and safety of tolvaptan in patients hospitalized with acute heart failure. J Am Coll Cardiol. 2017;69(11):1399–406. doi: 10.1016/j.jacc.2016.09.004
Imamura T, Kinugawa S, Muramatsu T, Shiga T, Ogimoto A, Anzai T, et al. Long-term tolvaptan treatment in refractory Heart Failure. Circ Rep. 2019;1(10):431–7. doi: 10.1253/circrep.CR-19-0064
Mullens W, Damman K, Harjola VP, Mebazaa A, Brunner-La Rocca HP, Martens P, et al. The use of diuretics in heart failure with congestion-A position statement from the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail. 2019;21(2):137–55. doi: 10.1002/ejhf.1369
Sastroasmoro S, Ismael S. Dasar-dasar metodologi penelitian klinis esdisi ke-5. Jakarta: Sagung Seto; 2014.
DOI: https://doi.org/10.15416/ijcp.2022.11.1.66
Refbacks
- There are currently no refbacks.
Indonesian Journal of Clinical Pharmacy is indexed by
