P122: Meta-Analysis on Aggregate Data and Individual Patient Data
Poster Presenter
Yen Phan
Doctoral Student
The George Washington University Ireland
Objectives
This research investigates the impact of loop diuretics on weight changes in heart failure patients through a meta-analysis, consolidating data to enhance clinical understanding and optimize treatment strategies for subgroup populations.
Method
The study was conducted in 2024 using meta-analysis on five IPD datasets from Vivli. Data from Bayer, GSK, and Boehringer Ingelheim included heart failure patients on loop or thiazide diuretics. Mixed-effects linear regression assessed weight change and treatment effects.
Results
The study collected quantitative data from five individual patient data (IPD) datasets and five aggregate data (AD) sources. Key variables included baseline weight, post-treatment weight, weight change (kg), total daily dose of loop diuretics (LD) and thiazide diuretics (TD), age, sex, adverse event duration, and severity. The primary research question examined whether LDs were more effective than TDs in reducing weight among heart failure (HF) patients.
Findings showed that both LDs and TDs contributed to weight loss, but LDs led to greater reductions. On average, LDs reduced weight by -3.52 ± 2.32 kg, while TDs achieved -1.35 ± 0.65 kg. However, adverse event duration was longer for LD users, suggesting potential risks. Subgroup analysis revealed that higher LD doses (>30 mg) did not always correlate with increased weight loss, and older patients (=65 years) experienced similar reductions as younger patients.
The study confirmed the tested hypothesis that LDs were more effective than TDs in weight reduction. However, variability in weight loss across studies highlighted differences in patient characteristics, dosage, and study designs. Trial sequential analysis validated the robustness of the meta-analysis, confirming significant findings. While LDs showed superior efficacy, TDs might still be useful in mild HF cases.
Conclusion
The study concluded that loop diuretics (LDs) are more effective than thiazide diuretics (TDs) in reducing weight among heart failure (HF) patients, confirming their role in managing fluid overload. However, weight loss varied across studies, indicating differences in patient characteristics, dosage, and treatment approaches. Higher LD doses did not always lead to greater weight loss, and older patients (=65 years) responded similarly to younger patients.
Clinical implications suggest that while LDs should remain the preferred choice for HF treatment, TDs may still be effective in mild cases. Additionally, the longer adverse event duration in LD users highlights the need for careful monitoring of potential risks. Combining LDs with TDs could be beneficial in some acute cases where LDs alone become less effective over time.
These findings contribute to personalized treatment strategies, guiding clinicians in optimizing diuretic therapy based on patient profiles. Future research should explore the long-term effects of LDs, potential resistance, and alternative treatment combinations to improve HF management and patient outcomes.
