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Safety and Efficacy of Tolvaptan in Korean Patients with Hyponatremia Caused by the Syndrome of Inappropriate Antidiuretic Hormone

Title
Safety and Efficacy of Tolvaptan in Korean Patients with Hyponatremia Caused by the Syndrome of Inappropriate Antidiuretic Hormone
Author
김근호
Keywords
Hyponatremia; Inappropriate ADH Syndrome; Tolvaptan
Issue Date
2018-04
Publisher
KOREAN ACAD MEDICAL SCIENCES
Citation
JOURNAL OF KOREAN MEDICAL SCIENCE, v. 33, no. 15, Article no. UNSP e112
Abstract
Background: The aim of this multicenter study was to evaluate the safety and efficacy of tolvaptan (TLV) in Korean patients with the syndrome of inappropriate secretion of antidiuretic hormone (SIADH).Methods: Of 51 enrolled patients with SIADH, 39 patients (16 female patients, aged 70.8 +/- 11.3 years) were included in an intention to treat analysis. All patients received 15 mg/day as the initial dose, and the dose was then increased up to 60 mg/day (as needed) until day 4.Results: Serum sodium increased significantly from baseline during the first 24 hours (126.8 +/- 4.3 vs. 133.7 +/- 3.8 mmol/L, P < 0.001), rose gradually between days 1 and 4 (133.7 +/- 3.8 vs. 135.6 +/- 3.6 mmol/L, P < 0.05), and then plateaued until day 11 (136.7 +/- 4.5 mmol/L). The correlation between the change in serum sodium for the first 24 hours and initial serum sodium concentration was significant (r = -0.602, P < 0.001). In severe hyponatremia (< 125 mmol/L), the change was significantly higher (11.1 +/- 4.8 mmol/L) than in moderate (6.4 +/- 2.5 mmol/L, P < 0.05) or mild hyponatremia (4.3 +/- 3.3 mmol/L, P < 0.01). In addition, logistic regression analysis showed that body weight (odds ratio [OR], 0.858; 95% confidence interval [CI], 0.775-0.976; P = 0.020) and body mass index (BMI) (OR, 0.692; 95% CI, 0.500-0.956; P = 0.026) were associated with rapid correction. No serious adverse events were reported, but in 13% of patients hyponatremia was overcorrected.Conclusion: TLV is effective in correcting hyponatremia and well-tolerated in Korean patients with SIADH. However, those with low body weight, low BMI or severe hyponatremia, could be vulnerable to overcorrection with the initial dose of 15 mg TLV.
URI
https://jkms.org/DOIx.php?id=10.3346/jkms.2018.33.e112http://repository.hanyang.ac.kr/handle/20.500.11754/118320
ISSN
1011-8934; 1598-6357
DOI
10.3346/jkms.2018.33.e112
Appears in Collections:
COLLEGE OF MEDICINE[S](의과대학) > MEDICINE(의학과) > Articles
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