Дронедарон

[Sergey Chevychelov]

Title: Dronedarone for Atrial Fibrillation: Have We Expanded the Antiarrhythmic Armamentarium?
Topic: Arrhythmias
Date Posted: 4/22/2010
Author(s): Singh D, Cingolani E, Diamond GA, Kaul S.
Citation: J Am Coll Cardiol 2010;55:1569-1576.
Clinical Trial: No
Related Resources
JACC Article: Dronedarone for Atrial Fibrillation: Have We Expanded the Antiarrhythmic Armamentarium?

Conclusions: The following are 10 points to remember from this review of dronedarone:

1. Dronedarone was designed to eliminate the organ toxicity of amiodarone (its parent compound) without compromising efficacy.

2. Dronedarone is metabolized by CYP3A4, and the dosage of drugs that inhibit this cytochrome should be adjusted to avoid overexposure to dronedarone.

3. The half-life of dronedarone is 30 hours compared to approximately 2 months for amiodarone.

4. Dronedarone inhibits tubular secretion of creatinine and causes a 10-15% increase in serum creatinine without reducing the glomerular filtration rate.

5. The pooled results of four randomized trials demonstrate that dronedarone prevented a recurrence of atrial fibrillation (AF) in 57% of patients, compared to 46% with placebo.

6. In a randomized trial, dronedarone was 50% less effective than amiodarone for preventing AF and was not significantly better tolerated.

7. Dronedarone increases the risk of death in patients with severe or recently decompensated heart failure (HF).

8. In a clinical trial, dronedarone was associated with a 24% reduction in the risk of cardiovascular hospitalization and did not significantly affect mortality.

9. The main side effects of dronedarone are diarrhea, nausea, and rash, and there is no evidence that dronedarone causes proarrhythmia or endocrine, neurological, or pulmonary toxicity.

10. The available data support the limited use of dronedarone in patients without recently decompensated HF, mostly as a second-line agent as an alternative to amiodarone.
Perspective: It is clear that dronedarone is not what many had hoped for, namely ‘a safe amiodarone.’ Freedom from organ toxicity comes with the price of lower efficacy than amiodarone. This, along with the high cost ($9/day retail), may limit its use in clinical practice. Fred Morady, M.D., F.A.C.C.