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Lower doses of carvedilol in Japanese heart failure patients with reduced ejection fraction could show the potential
Makiko Maeda1,2,3, Douglas Humber4,5, Eisuke Hida6
1Laboratory of Clinical Pharmacology, Department of Pharmaceutical Sciences, Osaka University, Osaka, Japan.
Plos One
|March 7, 2024
Summary
Japanese patients with heart failure with reduced ejection fraction (HFrEF) tolerate lower carvedilol doses than US patients. Despite dose differences, carvedilol effectiveness appears comparable, suggesting de-escalation may be viable for some patients.
Area of Science:
- Cardiology
- Pharmacology
- Real-world Evidence
Background:
- International guidelines differ on carvedilol dosing for heart failure with reduced ejection fraction (HFrEF).
- Japanese guidelines recommend lower carvedilol doses compared to US guidelines.
Purpose of the Study:
- To compare carvedilol dosing, tolerability, and outcomes between Japanese patients (JPNs) and US patients (USPs).
- To investigate differences in dosing among Caucasians (CAs) and Asian Americans (ASAs) within the USP cohort.
Main Methods:
- Retrospective analysis of real-world data from electronic medical records.
- Comparison of carvedilol initiation and target doses, dose adjustments, and cardiovascular events.
- Inclusion of demographic, clinical, and laboratory data from UCSD Health and Osaka University.
Main Results:
- JPNs received significantly lower initial and one-year carvedilol doses than USPs.
- JPNs had a lower relative rate of dose discontinuation and reduction compared to USPs.
- No significant differences in cardiac functional indicators or event-free survival were observed between JPNs and USPs.
Conclusions:
- Lower carvedilol doses in JPNs may achieve comparable effectiveness to higher doses in USPs for HFrEF.
- Dose de-escalation, rather than discontinuation, could be a therapeutic option for Asian and Asian American patients intolerant to high carvedilol doses.
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