Torsemide does not confer any survival benefit over Furosemide in HF: TRANSFORM HF trial

Researchers have found in a new study that people treated with either loop diuretic medication furosemide or torsemide had similar death and hospitalization rates, after hospital discharge for heart failure.

TRANSFORM-HF trial compared the loop diuretics Torsemide efficacy over Furosemide and found that Torsemide could not reduce the mortality rates or hospitalizations in patients with decompensated heart failure when compared to Furosemide.

The trial results were presented at American Heart Association Scientific Sessions in Chicago, IL, on November 5, 2022. 

Decompensated heart failure is the most common morbid condition affecting worldwide. Loop diuretics are generally prescribed for management. Among these, furosemide is the most commonly prescribed drug. But recent data suggested the usage of Torsemide for the same. Hence researchers conducted a trial to evaluate furosemide compared with torsemide after hospitalization for decompensated heart failure. TRANSFORM-HF is a large-scale, pragmatic, randomized, unblinded, open-label clinical effectiveness study comparing torsemide versus furosemide as treatment for heart failure. 

Nearly 2859 patients with a mean age of 64 years and hospitalized with decompensated heart failure regardless of ejection fraction were enrolled in the study. They were randomized to the furosemide group having 1,428 patients and torsemide group having 1,431 patients after discharge. They were followed up for 17.4 months. All-cause mortality was the primary outcome of measurement and All-cause mortality, or hospitalization was the secondary outcome of the measurement. 

Results: 

• Nearly 26.2% of the furosemide group and 26.1% of the torsemide group (p = 0.77) had mortality.
• All-cause mortality or hospitalization was seen in 49.3% of the furosemide group and 47.3% of the torsemide group. 
• Post-discharge management with torsemide was not superior to furosemide. All-cause mortality was similar between treatment groups. Either furosemide or torsemide are acceptable options for diuresis among patients with heart failure. 

The study's lead author Robert J. Mentz, M.D., FAHA, an associate professor of medicine, an associate professor of population health sciences at Duke University School of Medicine, and chief of the heart failure section at Duke Clinical Research Institute in Durham, North Carolina said "We were disappointed at first because we hoped that there would be a significant clinical difference between these two medicines based on prior studies and clinical experience. While we did not see better outcomes with torsemide, these results help inform our ability to take better care of people living with heart failure." 

Further reading: Presented by Dr. Robert J. Mentz at the American Heart Association Scientific Sessions, Chicago, IL, November 5, 2022.