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ESC Spokespersons react to COMET results presented today at Heart Failure / ISHR-ES 2003
June 23, 2003Monday 23 June, Strasbourg, France: The COMET, The Carvedilol or Metoprolol European Trial, results were presented a Hot Line Session this morning at Heart Failure / ISHR-ES 2003, the meeting of the European Society of Cardiology's Working Group on Heart Failure, held jointly this year with the Annual Congress of the European Section of the International Society for Heart Research. Here, three ESC Spokespersons who attended the COMET presentations give their interpretations of the results and their implications.
Professor Lars Rydén, Karolinska Hospital, Stockholm, Sweden - ESC Spokesperson
"These are very interesting results. COMET is a very well thought through and well conducted trial, thus it must be taken very seriously as an excellent piece of clinical research and point of reference for future treatment.
"The results may be astonishing for some, but are not completely unexpected. A number of details from observational and clinical studies have suggested that carvedilol demonstrates unique features in mortality reduction.
"What COMET specifically highlights is that drugs in the same class cannot necessarily be judged as having the same effects, thus we should see drugs, in this case beta blockers, separately and not overly categorise. Not many head-to-head comparisons of this type have been conducted to date, but when they are, the results are of great clinical value. Hopefully more such comparative trials will be conducted in the future.
"Clinicians should make a point of reading the study paper when it is published (The Lancet, 5 July 2003) and taking the results into account in clinical practice".
Professor Michal Tendera, Silesian School of Medicine, Katowice, Poland - ESC President-Elect & ESC Spokesperson
"The results of this study are indeed spectacular, but it should be noted that the form of metoprolol used in COMET is different to that used in other studies, such as MERIT-HF where metoprolol demonstrated a 34% increase in survival over placebo, so metoprolol is clearly an active drug. Perhaps carvedilol is better, as COMET suggests, but this is not to say that by any means that metoprolol is not clinically effective".
Professor Helmut Drexler, Medizinische Hochschule, Hannover, Germany - ESC Spokesperson
"Whilst the COMET results are clearly of major importance, there is expert opinion that the dosing of the two beta-blockers may not have been completely equal. Matched dosing is crucial for appropriate interpretation of the results. It is probably fair to say that carvedilol is superior to metoprolol, but the mortality difference demonstrated by COMET does appear a little too great (17% lower in carvedilol) to be certain of confidence in these results."
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European Society of Cardiology (ESC)
"The results may be astonishing for some, but are not completely unexpected. A number of details from observational and clinical studies have suggested that carvedilol demonstrates unique features in mortality reduction.
"What COMET specifically highlights is that drugs in the same class cannot necessarily be judged as having the same effects, thus we should see drugs, in this case beta blockers, separately and not overly categorise. Not many head-to-head comparisons of this type have been conducted to date, but when they are, the results are of great clinical value. Hopefully more such comparative trials will be conducted in the future.
"Clinicians should make a point of reading the study paper when it is published (The Lancet, 5 July 2003) and taking the results into account in clinical practice".
Professor Michal Tendera, Silesian School of Medicine, Katowice, Poland - ESC President-Elect & ESC Spokesperson
"The results of this study are indeed spectacular, but it should be noted that the form of metoprolol used in COMET is different to that used in other studies, such as MERIT-HF where metoprolol demonstrated a 34% increase in survival over placebo, so metoprolol is clearly an active drug. Perhaps carvedilol is better, as COMET suggests, but this is not to say that by any means that metoprolol is not clinically effective".
Professor Helmut Drexler, Medizinische Hochschule, Hannover, Germany - ESC Spokesperson
"Whilst the COMET results are clearly of major importance, there is expert opinion that the dosing of the two beta-blockers may not have been completely equal. Matched dosing is crucial for appropriate interpretation of the results. It is probably fair to say that carvedilol is superior to metoprolol, but the mortality difference demonstrated by COMET does appear a little too great (17% lower in carvedilol) to be certain of confidence in these results."
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European Society of Cardiology (ESC)
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