This study is important and will be added to my heart failure talk that I am giving in 3 weeks. Pfizer Halts Eplerenone HF Trial Early Due to Drug Benefit This article may well expand the indication for aldosterone blockade. Currently we have indications for spironactone for class III CHF and for decreased LVEF after MI. Now we likely have another indication.
Eplerenone costs significantly more than the generic spironalactone, but it does have less side effects. If I had class II heart failure with decreased EF I would now probably take eplerenone.
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Stopping trials of new drugs early has its own complications. Eplerenone has not been around forever, and longer term studies may produce different outcomes than suggested when studies are stopped early. Long term outcomes are not always simply extensions of short term benefits. While there are obvious ethical arguments for early cessation, stopping a trial early makes sure we will never know if longer term treatment exposes new risks to patients.
Agree with J Nicholas, not quite there yet. It would be a sign of desperation if I had class II heart failure with decreased EF and I decided to take eplerenone.
Was there a plan to compare eplerenone with spironolactone at any point? Placebo controlled trials do not yield the same decision-guiding information as trials that compare new with established treatments.
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