Congestive heart failure in dogs: torasemide vs furosemide — LIKELY

In dogs with congestive heart failure, how does oral torasemide compare with oral furosemide for treatment success and time to cardiac death, euthanasia or worsening heart failure?

Shelf #206 · gate-verified and approved by the developer

LIKELY: Two large randomised trials in dogs with congestive heart failure from degenerative mitral valve disease agree that once-daily oral torasemide is noninferior to twice-daily furosemide for treatment success, and both found torasemide dogs less likely to reach hard cardiac endpoints. TEST (Chetboul 2017; 366 dogs; prospective randomised single-blinded — single-blinding is stated in the record itself) was noninferior in both component studies (+7%; 95% CI [-8%; +22%] and +1%; 95% CI [-12%; +14%]) and torasemide was associated with a relative reduction in the risk of the composite cardiac endpoint (adjusted HR = 0.47; 95% CI = 0.27-0.82; P = 0.0077). CARPODIEM (Besche 2020; 319 dogs with new-onset CHF; double-blinded randomised) was noninferior at day 14 (74.4% vs 73.5% meeting the primary criterion; risk ratio 1.01) and at day 84, with torasemide dogs less than half as likely in relative terms to experience death, euthanasia or premature withdrawal (hazard ratio 0.36; 95% CI 0.19-0.65; P = .001). Tier C (the benefit claim rests in part on composite endpoints that include spontaneous cardiac death and euthanasia due to heart failure, alongside CHF class worsening or study withdrawal — not on all-cause mortality alone). The small Peddle 2012 crossover (7 dogs) is consistent on clinical control but showed creatinine and urea rising on torsemide, a reminder to monitor renal values. Evidence is for DMVD heart failure only, over about 3 months, with industry involvement in both large trials. Drafted Nov 10, 2026 (VetMed build, topic #206); all figures from abstracts fetched and verified at drafting.

Chetboul 2017 (TEST): torasemide noninferior to furosemide in 366 DMVD dogs, with a relative halving of composite cardiac endpoint risk

Analysis of 2 prospective randomized single-blinded reference-controlled trials (record's own wording; publication type Clinical Trial)

Who: Dogs: 366 dogs with congestive heart failure attributable to degenerative mitral valve disease, in a multicentre clinical trial setting, orally receiving either torasemide once daily (n = 180) or furosemide twice daily (n = 186) in addition to standard CHF therapy over 3 months; analysis of 2 prospective randomized single-blinded reference-controlled trials.

Result: Torasemide was noninferior to furosemide (Ptorasemide - Pfurosemide = +7%; 95% CI [-8%; +22%] and Ptorasemide - Pfurosemide = +1%; 95% CI [-12%; +14%], respectively, in Study 1 and Study 2). Torasemide (median dose = 0.24 mg/kg/d q24h; range = 0.10-0.69 mg/kg/d) was associated with a 2-fold reduction in the risk of reaching the composite cardiac endpoint (adjusted HR = 0.47; 95% CI = 0.27-0.82; P = 0.0077) as compared with furosemide (median dose = 1.39 mg/kg q12h; range = 0.70-6.30 mg/kg q12h). The authors concluded torasemide q24h is an effective oral diuretic in dogs with CHF.

Watch out: Single-blinded only — the record states single-blinded, not double-blinded, so do not upgrade it. The headline endpoint is a composite (spontaneous cardiac death, euthanasia due to heart failure, or CHF class worsening); the record does not give the separate absolute rates for cardiac death alone, so the HR = 0.47 is a relative measure for the composite and must not be read as a mortality-only effect. Several authors were employees of the torasemide manufacturer (Vetoquinol) per the affiliations on the record.

Chetboul V, Pouchelon JL, Menard J, Blanc J, Desquilbet L, Petit A, Rougier S, Lucats L, Woehrle F; TEST study investigators. Short-Term Efficacy and Safety of Torasemide and Furosemide in 366 Dogs with Degenerative Mitral Valve Disease: The TEST Study. Journal of Veterinary Internal Medicine. 2017;31(6):1629-1642. PMID: 28975664. Registry ID: none in the record. MeSH: Animals · Diuretics/adverse effects · Diuretics/therapeutic use · Dogs · Female · Furosemide/adverse effects · Furosemide/therapeutic use · Heart Failure/drug therapy · Heart Failure/mortality · Heart Failure/veterinary · Heart Valve Diseases/veterinary · Male · Mitral Valve · Prospective Studies · Sulfonamides/adverse effects · Sulfonamides/therapeutic use · Torsemide · Treatment Outcome

Besche 2020 (CARPODIEM): double-blinded torasemide noninferior at day 14 and day 84, with lower relative risk of death, euthanasia or withdrawal

Double-blinded randomized noninferiority study (record's own wording; publication type Randomized Controlled Trial, Veterinary)

Who: Dogs: 319 dogs with new onset congestive heart failure attributable to degenerative mitral valve disease, in a clinical trial setting, receiving PO torasemide once daily (n = 161) or furosemide twice daily (n = 158) in addition to standard CHF treatment; primary efficacy criterion was decreased pulmonary edema and cough and no worsening of dyspnea or exercise tolerance at day 14.

Result: Torasemide q24h was noninferior to furosemide q12h; the percentage of dogs meeting the primary efficacy criterion at day 14 was similar between groups (torasemide, 74.4% [95% confidence interval (CI), 66.8%-81.0%] vs. furosemide, 73.5% [95% CI, 65.7%-80.4%]; risk ratio [RR], 1.01; 95% CI, 0.89-1.15; P = .87). Efficacy at day 84 showed similar results (RR, 1.05; 95% CI, 0.88-1.25; P = .6). Dogs receiving torasemide had a longer time to endpoint and were less than half as likely to experience death, euthanasia, or premature study withdrawal (hazard ratio, 0.36; 95% CI, 0.19-0.65; P = .001) than dogs receiving furosemide at any time during the study.

Watch out: The hazard ratio 0.36 is a relative measure for a composite that includes premature study withdrawal for cardiac reasons, not death alone, and the abstract does not print the absolute event rates for that endpoint — only the day-14 and day-84 efficacy percentages above are absolute. First-occurrence CHF from DMVD only; follow-up was 84 days. Lead authors were employees of the torasemide manufacturer (Ceva Santé Animale) per the affiliations on the record.

Besche B, Blondel T, Guillot E, Garelli-Paar C, Oyama MA. Efficacy of oral torasemide in dogs with degenerative mitral valve disease and new onset congestive heart failure: The CARPODIEM study. Journal of Veterinary Internal Medicine. 2020;34(5):1746-1758. PMID: 32767627. Registry ID: none in the record. MeSH: Animals · Diuretics/therapeutic use · Dog Diseases/drug therapy · Dogs · Furosemide/therapeutic use · Heart Failure/drug therapy · Heart Failure/veterinary · Male · Mitral Valve · Sulfonamides/therapeutic use · Torsemide

Peddle 2012: in 7 stable CHF dogs, torsemide controlled signs as well as furosemide over 7-day crossover periods, with creatinine and urea higher on torsemide

Double-blinded, randomized, crossover study (record's own wording; publication type Randomized Controlled Trial)

Who: Dogs: 7 client-owned dogs with stable congestive heart failure secondary to mitral valve disease, already receiving twice daily oral furosemide and adjunctive medications, in a double-blinded, randomized, crossover design: oral furosemide at their current dose or an equivalent oral dose of torsemide (1/10 of the daily furosemide dose divided into twice daily dosing) from day 0, crossover at day 7, study end day 14, with clinical, laboratory, radiographic and quality-of-life variables on days 0, 7 and 14.

Result: No dogs developed recurrent CHF during the study. Mean furosemide dose on day 0 was 5.13 mg/kg/day (range 2.8-9.6). Following torsemide treatment, creatinine (P = 0.020), urea nitrogen (P = 0.013), phosphorus (P = 0.032), albumin (P = 0.019), carbon dioxide (P = 0.015) and anion gap (P = 0.005) were significantly increased, and urine specific gravity (P = 0.004) and chloride (P = 0.021) were significantly decreased compared with furosemide dosing. No differences in quality of life were found. The authors concluded torsemide is equivalent to furosemide at controlling clinical signs of CHF in dogs and is likely to achieve greater diuresis, while calling for larger trials.

Watch out: Only 7 dogs and 7 days per treatment — this card can only support short-term clinical control and laboratory signals, not outcomes. The draft anchor dated this study 2021; the record is 2012. The rises in creatinine and urea nitrogen on torsemide are the safety counterweight to the large trials' endpoint findings and argue for renal monitoring after a switch.

Peddle GD, Singletary GE, Reynolds CA, Trafny DJ, Machen MC, Oyama MA. Effect of torsemide and furosemide on clinical, laboratory, radiographic and quality of life variables in dogs with heart failure secondary to mitral valve disease. Journal of Veterinary Cardiology. 2012;14(1):253-9. PMID: 22364690. Registry ID: none in the record. MeSH: Animals · Cross-Over Studies · Diuretics/therapeutic use · Dog Diseases/drug therapy · Dogs · Furosemide/therapeutic use · Heart Failure/drug therapy · Heart Failure/etiology · Heart Failure/veterinary · Mitral Valve Insufficiency/complications · Mitral Valve Insufficiency/veterinary · Sulfonamides/therapeutic use · Torsemide

Synthesis: torasemide once daily is noninferior to furosemide twice daily in DMVD heart failure, with a consistent relative advantage on composite cardiac endpoints

Synthesis

Who: Synthesis of the cards above: Chetboul 2017 TEST (366 dogs with DMVD CHF, randomised single-blinded, torasemide q24h n = 180 vs furosemide q12h n = 186, 3 months), Besche 2020 CARPODIEM (319 dogs with new-onset DMVD CHF, double-blinded randomised, torasemide n = 161 vs furosemide n = 158, to day 84) and Peddle 2012 (7 stable CHF dogs, double-blinded randomised crossover, 7 days per drug).

Result: (1) Noninferiority for treatment success was shown in both large trials, with near-identical absolute success rates where printed (CARPODIEM day 14: 74.4% torasemide vs 73.5% furosemide). (2) Both large trials found torasemide dogs at lower relative risk of composite hard endpoints (TEST adjusted HR = 0.47; CARPODIEM HR = 0.36), but neither abstract separates cardiac death alone, so a mortality-only benefit is not established. (3) Peddle's laboratory findings (creatinine and urea higher on torsemide) show the stronger diuresis is not free — renal values should be checked after switching.

Watch out: All carded evidence is degenerative mitral valve disease heart failure in dogs, treated orally for at most about 3 months; it does not cover dilated cardiomyopathy, acute IV decongestion, or long-term survival. Both large trials were manufacturer-linked, which is a reason the stamp is LIKELY rather than PROBABLE despite two concordant blinded trials.

Synthesis of Chetboul V et al. PMID: 28975664; Besche B et al. PMID: 32767627; Peddle GD et al. PMID: 22364690. Registry IDs as on the individual cards.

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