Efficacy of Telmisartan to slow growth of small abdominal aortic aneurysms: a randomized clinical trial

Golledge, Jonathan, Pinchbeck, Jenna, Tomee, Stephanie M., Rowbotham, Sophie E., Singh, Tejas P., Moxon, Joseph V., Jenkins, Jason S., Lindeman, Jan H., Dalman, Ronald L., McDonnell, Lori, Fitridge, Robert, Morris, Dylan R., and TEDY Investigators, (2020) Efficacy of Telmisartan to slow growth of small abdominal aortic aneurysms: a randomized clinical trial. Jama Cardiology, 5 (12). pp. 1374-1381.

[img] PDF (Published Version) - Published Version
Restricted to Repository staff only

View at Publisher Website: https://doi.org/10.1001/jamacardio.2020....
 
4
1


Abstract

Importance: Currently there is no drug therapy for abdominal aortic aneurysm (AAA).

Objective: To test the efficacy of the angiotensin receptor blocker telmisartan in slowing AAA growth in the Telmisartan in the Management of Abdominal Aortic Aneurysm (TEDY) trial.

Design, Setting, and Participants: A randomized, double-blind, placebo-controlled trial recruited participants between September 6, 2011, and October 5, 2016, to evaluate the efficacy of telmisartan treatment in patients with AAA. Participants with 35- to 49-mm AAAs recruited from Australia, the Netherlands, and the US were randomized 1:1 to receive telmisartan, 40 mg, or identical placebo. Analyses were conducted according to intention-to-treat principles. Final follow-up was conducted on October 11, 2018, and data analysis was performed between June and November 2019.

Intervention: Telmisartan, 40 mg, or identical placebo.

Main Outcomes and Measures: The primary outcome of the difference in AAA growth, assessed on core imaging laboratory-read ultrasonographic scanning, was tested with linear mixed-effects models. Other outcomes included effects on blood pressure, computed tomographic (CT)–measured AAA diameter and volume, time to AAA-related events (AAA repair or mortality due to AAA rupture), and health-related quality of life.

Results: Of 300 intended participants, 210 were enrolled and randomized to receive telmisartan (n = 107) or placebo (n = 103). Of patients included in the intention-to-treat analysis (telmisartan: n = 106, placebo: n = 101), 183 were men (88%); mean (SD) age was 73.5 (7.9) years. At 1 year, participants receiving telmisartan had mean lower systolic (8.9; 95% CI, 4.1-13.8 mm Hg; P < .001) and diastolic (7.0; 4.3-9.8 mm Hg; P < .001) blood pressure levels compared with participants receiving placebo. A total of 188 participants (91%) received at least 2 ultrasonographic scans and 133 participants (64%) had at least 2 CT scans. There was no significant difference in ultrasonographic-assessed AAA growth rates among those assigned telmisartan (1.68 mm/y) or placebo (1.78 mm/y): mean difference, −0.11 mm/y (95% CI, −0.60 to 0.38 mm/y; P = .66). Telmisartan had no significant effects on AAA growth assessed by CT-measured AAA diameter (mean difference, −0.01 mm/y; 95% CI, −0.02 to 0.01 mm/y; P = .23) or volume (mean difference, −0.02 cm3/y; 95% CI, −0.04 to 0.00 cm3/y; P = .11), AAA-related events (relative risk, 1.35; 95% CI, 0.54-3.35; P = .52), or health-related quality of life (mean difference in physical component score at 24 months, 0.4; 95% CI, 0.4-0.4; P = .80). Hypotensive symptoms (eg, syncope) were twice as common among participants receiving telmisartan compared with placebo (28 [26%] vs 13 [13%]; P = .02), but overall adverse event rates were otherwise similar for both groups.

Conclusions and Relevance: This underpowered study did not show a treatment effect for telmisartan on small AAA growth. Future trials will need to ensure adequate sample size and duration of follow-up.

Trial Registrations: anzctr.org.au Identifier: ACTRN12611000931976; ClinicalTrials.gov Identifier: NCT01683084

Item ID: 66109
Item Type: Article (Research - C1)
ISSN: 2380-6583
Keywords: Cardiology, Surgery, Vascular Surgery, Radiology
Copyright Information: © 2020 American Medical Association. All rights reserved.
Additional Information:

Jonathan Golledge, Joseph Moxon, Jenna Pinchbeck, Sophie E. Rowbotham, Dylan R. Morris, Tejas P Singh, Rene Jaeggi, Cindy Sealey, and Georgina Anderson are members of the TEDY Investigators.

Funders: National Health and Medical Research Council (NHMRC), BUPA Foundation, Townsville University Hospital, Medtronic Incorporated, Queensland Government (QG)
Projects and Grants: NHMRC grant 1022752, NHMRC Senior Research Fellowship 1117061, QC Advance Queensland fellowship, QC Junior doctor research fellowship
Date Deposited: 13 Jan 2021 07:36
FoR Codes: 32 BIOMEDICAL AND CLINICAL SCIENCES > 3201 Cardiovascular medicine and haematology > 320101 Cardiology (incl. cardiovascular diseases) @ 50%
32 BIOMEDICAL AND CLINICAL SCIENCES > 3202 Clinical sciences > 320226 Surgery @ 50%
SEO Codes: 20 HEALTH > 2001 Clinical health > 200102 Efficacy of medications @ 100%
Downloads: Total: 1
More Statistics

Actions (Repository Staff Only)

Item Control Page Item Control Page