Digoxin therapy: A persisting interest despite contrary winds.
Digoxin therapy is used to treat heart failure patients for more than 200 years. However, absence of effect on overall mortality found in the DIG study associated with frequent adverse effects due to overdosing in elderly patients with impaired renal function finally persuaded medical opinion to the weak interest of digoxin in chronic heart failure. Its image of old-fashioned drug in the mind of young cardiology generations appears widely distorted, and suffers from the absence of promotion by pharmaceutical industry, given a very low cost and a rapid arrival onto the generic market. Yet, regarding strict data from the literature, it remains a lot of positive factors in favor of the interest for digoxin: reduction of morbidity, reduction of mortality at low serum concentration <1.0 ng/ml, very low cost with favorable cost-effectiveness ratio. This article challenges some arguments for defending digoxin as another first-line therapy as well as ACE inhibitors and beta-blockers in the treatment of chronic heart failure.
Juillière
Yves
Y
Department of Cardiology, institut lorrain du coeur et des vaisseaux Louis-Mathieu, Vandoeuvre-les-Nancy, France. y.juilliere@chu-nancy.fr
Selton-Suty
Christine
C
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D002316:Cardiotonic Agents / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D004077:Digoxin / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D016527:Drug Costs; D004359:Drug Therapy, Combination; D019317:Evidence-Based Medicine; D006333:Heart Failure / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D018570:Risk Assessment; D016896:Treatment Outcome
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D002316:Cardiotonic Agents; D004077:Digoxin