A comparison of the effects of carvedilol and metoprolol on wellbeing, morbidity, and mortality the patient journey in patients with heart failure. In this analysis, we compare the effect of carvedilol and metoprolol on vascular events in the comet study. Articles comparison of carvedilol and metoprolol on clinical. Update with slide comet results show a 17% relative reduction in mortality with carvedilol vs metoprolol, but no significant difference in the coprimary end point of death or hospitalization. Here, carvedilol increased survival in patients with. In this context, the presentation of the longawaited results of the carvedilol or metoprolol european trial comet at the european working group on heart. Carvedilol program and two dedicated survival trials, the cardiac insuf.
Cleland, andrew charlesworth, jacobus lubsen, karl swedberg, willem j. This is the first direct comparison between metoprolol and carvedilol of longterm effect on survival in patients with chronic heart failure. Discontinuation of concurrent clonidine should be gradual, with carvedilol dis continued. Using our preliminary data from this study, we estimate that 520 patients 260 in each group would be required to achieve 90% power to detect a difference in a composite end point of improved vs not improved, comparing placebo with a single dose of carvedilol in children and adolescents with heart failure due to dilated cardiomyopathy. May 25, 2010 the importance of the findings in this study for the prognosis of patients is unknown, but the result could inspire to further studies of the importance of vascular insulin sensitivity given the favorable effects of carvedilol compared to metoprolol observed in the comet study the carvedilol or metoprolol european trial 3, 4. Adrenergic blockade is commonly and successfully used to treat chronic heart failure. We analysed data from comet, a trial comparing carvedilol and metoprolol tartans, to explore these issues further. Comparison of carvedilol and metoprolol on clinical. In the carvedilol or metoprolol european trial comet two beta blockers were compared in a doubleblind randomized matter. Prognostic importance of plasma ntpro bnp in chronic heart failure in patients treated with a. Find information on carvedilol coreg in daviss drug guide including dosage, side effects, interactions, nursing implications, mechanism of action, half life, administration, and more. The results of this study show that carvedilol extends survival by comparison with metoprolol in patients. In that study, carvedilol reduced the combined risk of death or hospitalization by 26 percent sharpe n.
Choosing metoprolol or carvedilol in heart failure a precomet commentary. Prognostic importance of plasma ntpro bnp in chronic heart. Comparison of carvedilol and metoprolol on clinical outcomes. Comparison of carvedilol and metoprolol on clinical outcomes in. In may, 2000, the steering committee, who had no knowledge of the interim results or treatment assignments, decided to add the composite endpoint of allcause mortality or allcause admission as a. The selection of appropriate outcomes is crucial when designing clinical trials in order to compare the effects of different interventions directly. Philip a poolewilson, md national heart and lung institute, imperial college london, uk analyses of the secondary endpoints for the carvedilol or metoprolol european trial comet. A report from the carvedilol or metoprolol european trial comet john g. Objectives this study was designed to investigate the loss of wellbeing, in terms of lifeyears, overall and in patients randomized to metoprolol versus carvedilol in the carvedilol or metoprolol european trial comet. Highlights of prescribing information these highlights do not include all the information needed to use coreg safely and effectively. A comparison of the effects of carvedilol and metoprolol. The study was planned as an eventdriven parallelgroup survival study to compare carvedilol and metoprolol with respect to allcause mortality.
The carvedilol or metoprolol european trial comet compared overall mortality in patients with heart failure, randomised to receive either carvedilol or metoprolol tartrate. Comparison of carvedilol and metoprolol on clinical outcomes in patients with chronic heart failure in the carvedilol or metoprolol european trial comet. Carvedilol compared with metoprolol succinate in the. Interpretation the results of comet are fairly definitive, according to professor poolewilson, and provide evidence that carvedilol is the preferred betablocker for the treatment of chronic hf. We designed this study to investigate whether carvedilol is associated with improved survival.
Carvedilol was more effective than metoprolol tartrate for lowering. Trial comet to compare directly the effects of carvedilol and metoprolol on mortality and morbidity in patients with mild to severe chronic heart failure. The 2003 carvedilol or metoprolol european trial comet randomized 3,029 patients with class iiiv heart failure to carvedilol or metoprolol. Effects of metoprolol and carvedilol on preexisting. Association of treatment with carvedilol vs metoprolol succinate and mortality in patients with heart failure.
Carvedilol vs metoprolol succinate and mortality jama. Comet, in return, was criticized both for its nonequivalent formulation and the inconsistent dosing. Methods comet was a doubleblind randomised controlled parallelgroup study of carvedilol vs. Articles comparison of carvedilol and metoprolol on.
Comet did not evaluate metoprolol succinate, the agent used in the merithf trial extrapolation from the survival curves suggested that carvedilol extended median survival by 1. Background the ultimate objectives of treating patients with heart failure are to relieve suffering and prolong life. Mar 06, 2007 the comet study was a randomized, doubleblind, parallel comparison of carvedilol, 25 mg twice a day, and metoprolol tartrate, 50 mg twice a day, in patients with stable chronic hf, new york heart association nyha functional class ii to iv and left ventricular dysfunction, in addition to standard therapy including ace inhibition and diuretics. For the findings to influence policy and practice, the outcomes need to be relevant and important to key stakeholders including patients and the public, health care professionals and others making decisions about health care.
Metoprolol controlled releaseextended release in patients. The study is funded by the patientcentered outcomes research institute pcori. This large cohort study of realworld patients with hf with reduced lvef contributes new data on the comparative effectiveness of carvedilol vs metoprolol succinate and supports similar clinical effectiveness of these 2 evidencebased drugs. The comet study provided a unique possibility to analyze the longterm effects on vascularrelated outcomes by these agents. The carvedilol prospective randomized cumulative survival copernicus trial article pdf available in current controlled trials in cardiovascular medicine 21. Pdf the carvedilol prospective randomized cumulative.
Evidencebased beta blockers american heart association. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. Is carvedilol superior to metoprolol in heart failure. Currently, many types of dcis are treated the same as invasive breast cancer. Methods design comet was a multicentre, randomised, doubleblind, parallelgroup trial to compare the effect on mortality and morbidity of carvedilol and metoprolol in patients with chronic heart failure. Influence of heart rate, blood pressure, and betablocker dose on outcome and the differences in outcome between carvedilol and metoprolol tartrate in patients with chronic heart failure. The comet study will enroll 1200 women with lowrisk dcis at about 100 cancer centers throughout the us. Here, carvedilol increased survival in patients with chf compared with metoprolol tartrate. Four us multicenter, doubleblind, placebocontrolled studies enrolled 1,094 patients 696 randomized to carvedilol with nyha class iiiii heart failure and ejection fraction study medication for open hblocker therapy in patients with stable heart failure and still on treatment at the end of comet.
The profile of the study is shown in figure 1 and the baseline characteristics are shown in table i. Background betablocking agents reduce the risk of hospitalization and death in patients with mildtomoderate heart failure, but little is known about their effects in severe heart failure. A comparison of the effects of carvedilol and metoprolol on. Results from the carvedilol or metoprolol european trial comet trial lars g. In the comet study, carvedilol improved survival compared to metoprolol tartrate in 3029 patients with nyha iiiv heart failure and ef comet was designed as an eventdriven study with coprimary endpoints of allcause mortality and the combined endpoint of mortality or hospitalization for any cause. Sparkc, michel komajdad, marco metrae, christian torppedersenf, willem j. Comet was a multicentre, randomised, doubleblind, parallelgroup trial to compare the effect on mortality and morbidity of carvedilol and metoprolol in patients with chronic heart failure. The effect of carvedilol on morbidity and mortality in. Remme, leif erhardt, andrea di lenarda, michel komajda, marco metra, christian torp. Effect of carvedilol on survival in severe chronic heart. Four us multicenter, doubleblind, placebocontrolled studies enrolled 1,094 patients 696 randomized to carvedilol with nyha class iiiii heart failure and ejection fraction.
The 2003 carvedilol or metoprolol european trial comet randomized 3,029 patients with class iiiv heart failure to carvedilol or metoprolol twice daily in addition to other medical therapies. Commentary on the carvedilol or metoprolol european trial comet. Pdf choosing metoprolol or carvedilol in heart failure. In the two survival trials, the betablockers bisoprolol and meto. Patients on metoprolol tartrate initially received 5 mg bid. Carvedilol in the treatment of chronic heart failure.
A detailed description of the study design has been published, including the method of randomisation, monitoring, and followup. Carvedilol protects better against vascular events than. This hypothesis was tested in the carvedilol or metoprolol european trial. This study was designed to investigate the loss of wellbeing, in terms of lifeyears, overall and in patients randomized to metoprolol versus carvedilol in the carvedilol. European trial comet, but before we launch into that discussion, i want to offer some background in the area of. First, it compared carvedilol with the shortacting metoprolol tartrate formulation. Get with the guidelines american heart association.
In comet, the researchers used the same drug regimen for carvedilol that was used in copernicus starting at 3. To investigate the relationship between heart rate, rhythm and betablocker dose with mortality according to assigned and received treatment in the carvedilol or metoprolol european trial comet. Patients were randomized to carvedilol or metoprolol tartrate and received initial doses of 3. Effects of metoprolol and carvedilol on causespecific. A total of 3029 patients was randomized, 1511 and 1518 to carvedilol and metoprolol, respectively. As with comet, more patients on carvedilol in our general cohort received target doses when compared with patients on metoprolol. The mean study duration was 58 6 months time from randomization to study closure. Effect of carvedilol and metoprolol on the mode of death in. The allcause mortality was signif icantly reduced in the favour of carvedilol. Methods the comet study was a randomized, doubleblind, parallel comparison of carvedilol, 25 mg twice a day, and. Carvedilol for children and adolescents with heart failure. Published in 2001, the carvedilol postinfarct survival control in lv dysfunction capricorn trial randomized 1,959 patients with hemodynamically stable mi in the past 321 days prior to randomization with reduced lvef of 40% or less and on an ace inhibitors unless with proven intolerance to receive carvedilol or placebo.