The Efficacy and Safety of Patiromer for Heart Failure Patients A Systematic Review and Meta-analysis

Abstract

Abstract Purpose To evaluate the efficacy and safety of patiromer, a novel potassium binder, in reducing the risk of hyperkalemia in patients with heart failure and optimizing the therapy of RAASi on them. Design Systematic review and meta-analyses. Method The authors conducted a systematic search in the Pubmed, Embase, Web of Science, and Cochrane Library for randomized controlled trials investigating efficacy and safety of patiromer in heart failure patients from inception to 31 January 2023 and updated on 25 March 2023. The primary outcome was the association between reduction of hyperkalemia and patiromer compared with placebo, and the secondary outcome was the association between optimization of RAASi therapy and patiromer. Results A total of four Randomized Controlled Trials (n=1163) were included in the study. Patiromer was found capable to reduce the risk of hyperkalemia in heart failure patients by 44% (RR 0.56, 95% CI 0.36 to 0.87; I2= 61.9%), improving tolerance to standard doses of MRA in patients with heart failure (RR 1.15, 95% CI 1.02 to 1.30; I2=49.4%), and decrease the proportion of all-cause discontinuation of RAASi (RR 0.49, 95%CI 0.25 to 0.98; I2=48.4%). However, patiromer therapy was associated with an increased risk of hypokalemia (RR 1.51, 95% CI 1.07 to 2.12; I2=0%), while no other statistically significant adverse events were observed. Conclusion Patiromer appears to have a considerable effect on reducing the incidence of hyperkalemia in heart failure patients and on optimizing the therapy of RAASi in those patients.