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Heart Failure Health Center

A Better Beta Blocker for Heart Failure

Patients Live Longer Taking Coreg Than Lopressor in First Head-to-Head Comparison
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Old Still Better Than New?

The COMET findings were presented last week in France at the Heart Failure 2003 meeting of the European Society of Cardiology. There, some questioned why a newer long-acting version of Lopressor, Toprol XL, wasn't used in the study. COMET was sponsored by F. Hoffmann-La Roche and GlaxoSmithKline, which market Coreg in the U.S. and as Dilatrend elsewhere. (GlaxoSmithKline is a sponsor of WebMD.)

Poole-Wilson, professor of cardiology at Imperial College in London, tells WebMD what he told them: The slow-release Lopressor formula -- the more widely used version in the U.S. -- was the only one available when the study began. But two experts not connected with the study say the long-action formula wouldn't likely affect study results.

"The Lopressor formula, taken twice daily was done in COMET, delivers the same dosage of beta-blocking properties as the newer Toprol XL tablet taken once daily," says Howard Eisen, MD, director of the Advanced Heart Failure and Transplant Center at Temple University School of Medicine.

'This Is Really Remarkable'

"This is a significant finding because it shows that one effective drug is better than another effective drug."

The two drugs compared in COMET were "apples and apples," adds Milton Packer, MD, director of the Center for Heart Failure Research and chief of the division of circulatory physiology at Columbia-Presbyterian Medical Center in New York.

"There aren't too many times when physicians and patients are given an opportunity to see a direct head-to-head comparison of two effective drugs, especially on an outcome as important as mortality," he tells WebMD. "This is really remarkable."

So why did Coreg seem so much better? Probably because it does more to help patients with heart failure.

While both Lopressor and Toprol XL block only beta 1 receptor cells, Coreg also blocks beta 2 and other receptor cells -- and also has antioxidative properties and additional effects not found in Lopressor, says Packer.

"Now which one of these additional properties, if any, is responsible for the difference, this trial couldn't determine. But clearly, what this trial shows is that one or more of these additional properties does matter for survival."

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