S2898 Comparison of the Efficacy of Torsemide and Furosemide in Managing Ascites Due to Liver Cirrhosis: A Systematic Review and Meta-Analysis

Introduction: Ascites management can be challenging, with loop diuretics and aldosterone antagonists forming the mainstay of therapy. While furosemide's efficacy is well-documented, its effectiveness can be limited. Torsemide offers potential advantages, including consistent oral bioavailability, higher potency, absorption unaffected by gut edema, and a longer half-life. Despite its pharmacokinetic advantages, torsemide's clinical superiority remains uncertain. We aim to conduct the first systematic review and meta-analysis to evaluate the comparative effectiveness of torsemide versus furosemide for the management of ascites in patients with liver cirrhosis. Methods: Multiple databases were searched through November 2024 for studies comparing furosemide and torsemide for ascites secondary to liver cirrhosis. The primary outcomes evaluated were diuresis and natriuresis at 24 hours and the secondary outcome was overall body weight change. Meta-analysis was performed to determine the pooled mean difference to compare outcomes. A random effects model was utilized for the study. Results: Four randomized controlled trials involving a total of 98 participants, were included in the final analysis. Forty-eight patients were treated with torsemide, while 50 patients were treated with oral furosemide. At the 24-hour mark, diuresis was more pronounced in the torsemide group (TG) compared to the furosemide group (FG), with a mean difference of 0.85 liters (95% CI 0.32-1.38, P = 0.002, I2 = 82%). Natriuresis at 24 hours was higher in the TG versus the FG, with a mean difference of 57.8 mmol (95% CI 18.05-97.54, P = 0.004, I2 = 76%). TG experienced a greater weight reduction, with a mean difference of 0.62 kilograms, however, this was not statistically significant but favored torsemide (95% CI - 0.28-1.52, P = 0.18, I2 = 79%). Conclusion: Our findings suggest that torsemide when compared to furosemide may enhance diuresis, natriuresis, and lead to a greater overall weight reduction in the management of hepatic ascites. Although our analysis is limited to 4 studies due to the paucity of randomized controlled trials on this topic. The effect beyond 24 hours need to be studied, and the heterogeneity observed in our study may stem from variations in the dosages used across different investigations, potentially limiting generalizability. Torsemide could be a promising alternative to furosemide, however, further research is needed to better elucidate the comparative long term effectiveness and safety profile in this patient population.