cardiovascularКардиоваскулярная терапия и профилактикаCardiovascular Therapy and Prevention1728-88002619-0125«SILICEA-POLIGRAF» LLCcardiovascular-2146Research ArticleКЛИНИЧЕСКИЕ ИССЛЕДОВАНИЯCLINICAL STUDIESРезультаты мета-анализа, сравнивающего переносимость лерканидипина и других дигидропиридиновых блокаторов кальциевых каналовResults of a meta-analysis comparing the tolerability of lercanidipine and other dihydropyridine calcium channel blockersМакароунас-КиршманнК.Makarounas-KirchmannK.

Department of Epidemiology and Preventative Medicine

Department of Epidemiology and Preventative Medicine

Glover-KoudounasS.Glover-KoudounasS.FerrariP.FerrariP.

Department of Nephrology

Department of Nephrology

KMC Health Care, Frankston, Victoria, Australia; Monash University, Melbourne, VictoriaKMC Health Care, Frankston, Victoria; Monash University, Melbourne, VictoriaMedical and Scientific Affairs, Australia and New Zealand, Solvay Pharmaceuticals Australia, Pymble, New South WalesMedical and Scientific Affairs, Australia and New Zealand, Solvay Pharmaceuticals Australia, Pymble, New South WalesFremantle Hospital and School of Medicine & Pharmacology, University of Western Australia, Perth, Western AustraliaFremantle Hospital and School of Medicine & Pharmacology, University of Western Australia, Perth, Western Australia201020122010966373Copyright © Макароунас-Киршманн К., Glover-Koudounas S., Ferrari P., 20102010Макароунас-Киршманн К., Glover-Koudounas S., Ferrari P.Makarounas-Kirchmann K., Glover-Koudounas S., Ferrari P.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://cardiovascular.elpub.ru/jour/article/view/2146Актуальность проблемы

Актуальность проблемы. Результаты клинических исследований позволяют предположить, что терапия дигидропиридиновым антагонистом кальция (дАК) лерканидипином может сопровождаться меньшей частотой развития периферических отеков, чем при применении дАК ранних генераций. Цель. Провести мета-анализ результатов опубликованных рандомизированных, контролируемых исследований (РКИ) для определения относительного риска (ОР) развития побочных эффектов (ПЭ), специфичных для дАК, при использовании лерканидипина в сравнении дАК ранних генераций (первое поколение: амлодипин, фелодипин и нифедипин) и другими липофильными c дАК (второе поколение: лацидипин и манидипин)**. Материал и методы. Систематический литературный поиск (включая все годы, вплоть до 11 августа 2008г) с использованием поисковых систем MEDLINE, EMBASE и Кокрановской Библиотеки проводили среди англоязычных публикаций, с целью выявления слепых или двойных слепых РКИ продолжительностью ≥4 нед., в которых сравнивалась переносимость лерканидипина и других дАК при лечении больных мягкой – артериальное давление (АД) – 140-159/90-99 мм рт.ст.) и умеренной – АД – 160-179/100-109 мм рт.ст.) артериальной гипертензией (АГ). Результаты. 8 РКИ*** (6 с использованием дАК первого поколения и 4 – дАК второго поколения) отвечали критериям включения. Эффективность снижения АД при терапии лерканидипином достоверно не отличалась от таковой при применении других поколений дАК. По сравнению с дАК первого поколения, прием лерканидипина ассоциировался со снижением риска периферических отеков – 52/742 для лерканидипина vs 88/627 для препаратов первого поколения; (ОР=0,44 [95% ДИ 0,31-0,63]), но не риска развития гиперемии лица или головной боли. Частота возникновения периферических отеков, гиперемии лица и головной боли статистически не отличалась на фоне приема лерканидипина и препаратов второго поколения. Пациенты, включенные в мета-анализ реже прекращали участие в РКИ из-за развития периферических отеков (ОР=0,24 [95% ДИ 0,12-0,47]) либо любых других ПЭ (ОР=0,51 [95% ДИ 0,33-0,77]) при назначении лерканидипина, чем препаратов первого поколения. Это различие отсутствовало при сравнении лерканидипина и препаратов второго поколения. Заключение. Лечение лерканидипином сопровождалось меньшим риском возникновения периферических отеков, а также меньшей вероятностью прекращения лечения из-за их развития, чем при лечении дАК первого, но не второго, поколения.

 

 

Background

Background. Results from clinical studies suggest that the dihydropyridine calcium channel blocker (d-CCB) lercanidipine may be associated with a lower incidence of peripheral edema than are older d-CCBs. Aim. To conduct a meta-analysis of published data from randomized controlled trials (RCTs) to assess the relative risk (RR) of d-CCB-specific adverse events (AE) with lercanidipine versus the older d-CCBs (first generation: amlodipine, felodipine, and nifedipine), and versus the other lipophilic d-CCBs (second generation: lacidipine and manidipine). Material and methods. A systematic literature search (all years, through August 11 2008) of MEDLINE, EMBASE, and the Cochrane Library was conducted for English-language reports of single- or double-blind RCTs of ≥4 weeks’ duration that compared the tolerability of lercanidipine with other d-CCBs in participants with mild (140- 159/90-99 mm Hg) and moderate (160-179/100-109 mm Hg) hypertension. Results. Eight RCTs (6 used first-generation drugs, and 4 used second-generation drugs) met the criteria for inclusion. Efficacy outcomes for lowering blood pressure did not differ statistically between lercanidipine and either generation of d-CCBs. Compared with the first generation, lercanidipine was associated with a reduced risk of peripheral edema (52/742 with lercanidipine vs. 88/627 with first generation; RR=0,44 [95% CI 0,31-0,63]), but not flushing or headache. The frequency of peripheral edema, flushing, and headache did not differ statistically between lercanidipine and the second generation drugs. Study participants were less likely to withdraw from the RCTs because of peripheral edema (RR=0,24 [95% CI 0,12-0,47]) or any AE (RR=0,51 [95% CI 0,33-0,77]) when treated with lercanidipine rather than a drug from the first generation, but not when treated with lercanidipine rather than second-generation drugs. Conclusion. Lercanidipine was associated with a lower risk of peripheral edema and a lower risk of treatment withdrawal because of peripheral edema than were the first-generation, but not the second-generation, d-CCBs.

 

 

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The authors declare that there are no conflicts of interest present.