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Carvedilol Has Significant Mortality Benefit Over Metoprolol: Presented at HF

By Douglas Reynolds

STRASBOURG, FRANCE -- June 23,2003 -- Carvedilol, a drug used in the treatment of heart failure, results in a significantly lower mortality rate compared to another beta-blocker, metoprolol.

Philip A. Poole-Wilson, MD, London, United Kingdom, presented the primary results of the Carvedilol or Metoprolol European Trial (COMET) here June 23^rd during the late breaking trials session at the Heart Failure 2003 conference, sponsored by the European Society of Cardiology and the International Society for Heart Research.

In COMET, 3029 patients with New York Heart Association class II and III were randomized to receive carvedilol 25 mg twice daily, or metoprolol tartrate 50 mg twice daily. The mean dose achieved was 42 mg and 85 mg daily, respectively.

Both agents lowered heart rate and blood pressure to a similar degree. The follow-up period was nearly 5 years, making it the longest heart failure trial conducted thus far.

The primary end point -- all-cause mortality -- showed that carvedilol-treated patients had a 17% lower mortality rate (P=.0017) than metoprolol-treated patients. The annualized mortality rates were 8.3% for the carvedilol group, compared with 10% for the metoprolol group. Overall, there were 512 deaths in the carvedilol group compared with 600 in the metoprolol group. Carvedilol use prolonged the median survival time by 1.4 years.

There was no discernable difference in the mode of death between the groups.

The analyzed co-primary end point, the combination of all-cause mortality and cardiovascular hospitalization, failed to show a significant difference between either group. After the 5-year follow-up period, 73.9% of 1511 carvedilol-treated patients met the end point, compared with 76.4% of 1518 metoprolol-treated patients.

Dr. Poole-Wilson said, "These results are significant, and show that the preferred beta-blocker in the treatment of heart failure should be carvedilol."

"The number of patients needed to treat to save 1 life in 1 year with carvedilol instead of metoprolol is 59," he said. The percentage of patients with adverse events, and the withdrawal rate were both lower with carvedilol.

Metoprolol tartrate is a beta1- selective agent, while carvedilol blocks beta1, beta2, and alpha1 adrenergic receptors. Both agents have been used to treat heart failure, usually in combination with angiotensin-converting enzyme inhibitors, diuretics, and digoxin.

COMET was the first head-to-head trial comparing mortality with 2 beta-blocking agents in patients with chronic heart failure.

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