What evidence was presented to the committee regarding clinical benefits and harms of Mineralocorticoid Receptor Antagonists (MRAs)?
The committee noted that although the confidence intervals were mostly indicating benefit there was also indication of increased mortality and hospitalisation. There was moderate quality evidence (from a smaller study that did not report number of events) that suggested an increase in the number of patients hospitalised for any cause in the intervention group compared to the placebo group, though this evidence was imprecise. The committee also acknowledged that the use of MRAs had no clinically important impact on quality of life or NYHA class. The committee was aware that post hoc analyses of the principle trial (TOPCAT) suggested a considerable degree of heterogeneity within the population recruited and that MRAs might habe differential effects in the different groups. They also noted the increased risk of gynaecomastia in patients taking spironolactone (estimate of 17 more per 1000), and that all of these effect estimates were subject to a high risk of bias likely to underestimate the effect.