Impact of dronedarone in atrial fibrillation and flutter on stroke reduction

Christine Benn Christiansen1, Christian Torp-Pedersen1, Lars Køber21Department of Cardiology, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark; 2Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, DenmarkBackground: Dronedarone has been developed...

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Autores principales:	Christine Benn Christiansen, Christian Torp-Pedersen, Lars Køber
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2010
Materias:	Antiarrhythmic therapy atrial fibrillation Dronedarone stroke Geriatrics RC952-954.6
Acceso en línea:	https://doaj.org/article/b2df60974a944269a1727fa752655126
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spelling	oai:doaj.org-article:b2df60974a944269a1727fa7526551262021-12-02T00:12:37ZImpact of dronedarone in atrial fibrillation and flutter on stroke reduction1178-1998https://doaj.org/article/b2df60974a944269a1727fa7526551262010-03-01T00:00:00Zhttps://www.dovepress.com/impact-of-dronedarone-in-atrial-fibrillation-and-flutter-on-stroke-red-peer-reviewed-article-CIAhttps://doaj.org/toc/1178-1998Christine Benn Christiansen1, Christian Torp-Pedersen1, Lars Køber21Department of Cardiology, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark; 2Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, DenmarkBackground: Dronedarone has been developed for treatment of atrial fibrillation (AF) or atrial flutter (AFL). It is an amiodarone analogue but noniodinized and without the same adverse effects as amiodarone.Objective and methods: This is a review of 7 studies (DAFNE, ADONIS, EURIDIS, ATHENA, ANDROMEDA, ERATO and DIONYSOS) on dronedarone focusing on efficacy, safety and prevention of stroke. There was a dose-finding study (DAFNE), 3 studies focusing on maintenance of sinus rhythm (ADONIS, EURIDIS and DIONYSOS), 1 study focusing on rate control (ERATO) and 2 studies investigating mortality and morbidity (ANDROMEDA and ATHENA).Results: The target dose for dronedarone was established in the DAFNE study to be 400 mg twice daily. Both EURIDIS and ADONIS studies demonstrated that dronedarone was superior to placebo for maintaining sinus rhythm. However, DIONYSOS found that dronedarone is less efficient at maintaining sinus rhythm than amiodarone. ERATO concluded that dronedarone reduces ventricular rate in patients with chronic AF. The ANDROMEDA study in patients with severe heart failure was discontinued because of increased mortality in dronedarone group. Dronedarone reduced cardiovascular hospitalizations and mortality in patients with AF or AFL in the ATHENA trial. Secondly, according to a post hoc analysis a significant reduction in stroke was observed (annual rate 1.2% on dronedarone vs 1.8% on placebo, respectively [hazard ratio 0.66, confidence interval 0.46 to 0.96, P = 0.027]). In total, 54 cases of stroke occurred in 3439 patients (crude rate 1.6%) receiving dronedarone compared to 76 strokes in 3048 patients on placebo (crude rate 2.5%), respectively.Conclusion: Dronedarone can be used for maintenance of sinus rhythm and can reduce stroke in patients with AF who receive usual care, which includes antithrombotic therapy and heart rate control.Keywords: atrial fibrillation, stroke, dronedaroneChristine Benn ChristiansenChristian Torp-PedersenLars KøberDove Medical PressarticleAntiarrhythmic therapyatrial fibrillationDronedaronestrokeGeriatricsRC952-954.6ENClinical Interventions in Aging, Vol Volume 5, Pp 63-69 (2010)
institution	DOAJ
collection	DOAJ
language	EN
topic	Antiarrhythmic therapy atrial fibrillation Dronedarone stroke Geriatrics RC952-954.6
spellingShingle	Antiarrhythmic therapy atrial fibrillation Dronedarone stroke Geriatrics RC952-954.6 Christine Benn Christiansen Christian Torp-Pedersen Lars Køber Impact of dronedarone in atrial fibrillation and flutter on stroke reduction
description	Christine Benn Christiansen1, Christian Torp-Pedersen1, Lars Køber21Department of Cardiology, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark; 2Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, DenmarkBackground: Dronedarone has been developed for treatment of atrial fibrillation (AF) or atrial flutter (AFL). It is an amiodarone analogue but noniodinized and without the same adverse effects as amiodarone.Objective and methods: This is a review of 7 studies (DAFNE, ADONIS, EURIDIS, ATHENA, ANDROMEDA, ERATO and DIONYSOS) on dronedarone focusing on efficacy, safety and prevention of stroke. There was a dose-finding study (DAFNE), 3 studies focusing on maintenance of sinus rhythm (ADONIS, EURIDIS and DIONYSOS), 1 study focusing on rate control (ERATO) and 2 studies investigating mortality and morbidity (ANDROMEDA and ATHENA).Results: The target dose for dronedarone was established in the DAFNE study to be 400 mg twice daily. Both EURIDIS and ADONIS studies demonstrated that dronedarone was superior to placebo for maintaining sinus rhythm. However, DIONYSOS found that dronedarone is less efficient at maintaining sinus rhythm than amiodarone. ERATO concluded that dronedarone reduces ventricular rate in patients with chronic AF. The ANDROMEDA study in patients with severe heart failure was discontinued because of increased mortality in dronedarone group. Dronedarone reduced cardiovascular hospitalizations and mortality in patients with AF or AFL in the ATHENA trial. Secondly, according to a post hoc analysis a significant reduction in stroke was observed (annual rate 1.2% on dronedarone vs 1.8% on placebo, respectively [hazard ratio 0.66, confidence interval 0.46 to 0.96, P = 0.027]). In total, 54 cases of stroke occurred in 3439 patients (crude rate 1.6%) receiving dronedarone compared to 76 strokes in 3048 patients on placebo (crude rate 2.5%), respectively.Conclusion: Dronedarone can be used for maintenance of sinus rhythm and can reduce stroke in patients with AF who receive usual care, which includes antithrombotic therapy and heart rate control.Keywords: atrial fibrillation, stroke, dronedarone
format	article
author	Christine Benn Christiansen Christian Torp-Pedersen Lars Køber
author_facet	Christine Benn Christiansen Christian Torp-Pedersen Lars Køber
author_sort	Christine Benn Christiansen
title	Impact of dronedarone in atrial fibrillation and flutter on stroke reduction
title_short	Impact of dronedarone in atrial fibrillation and flutter on stroke reduction
title_full	Impact of dronedarone in atrial fibrillation and flutter on stroke reduction
title_fullStr	Impact of dronedarone in atrial fibrillation and flutter on stroke reduction
title_full_unstemmed	Impact of dronedarone in atrial fibrillation and flutter on stroke reduction
title_sort	impact of dronedarone in atrial fibrillation and flutter on stroke reduction
publisher	Dove Medical Press
publishDate	2010
url	https://doaj.org/article/b2df60974a944269a1727fa752655126
work_keys_str_mv	AT christinebennchristiansen impactofdronedaroneinatrialfibrillationandflutteronstrokereduction AT christiantorppedersen impactofdronedaroneinatrialfibrillationandflutteronstrokereduction AT larskoslashber impactofdronedaroneinatrialfibrillationandflutteronstrokereduction
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Impact of dronedarone in atrial fibrillation and flutter on stroke reduction

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