1. Efficacy and safety of novel-targeted drugs in the treatment of pulmonary arterial hypertension: a Bayesian network meta-analysis
- Author
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Chunli Liu, Qian Jiang, Nuofu Zhang, Tao Wang, Lin Fu, Yuexin Li, Ni Ren, Yangxiao Chen, Xinni Wang, Yi Shen, Jingyi Liang, Yanghang Chen, Wenhai Fu, Hui Lei, Wenjun He, Dakai Xiao, and Ran Ma
- Subjects
medicine.medical_specialty ,Ambrisentan ,medicine.drug_mechanism_of_action ,Sildenafil ,Vasodilator Agents ,Network Meta-Analysis ,Pharmaceutical Science ,Walk Test ,02 engineering and technology ,RM1-950 ,Cochrane Library ,Placebo ,030226 pharmacology & pharmacy ,Severity of Illness Index ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,Adverse effect ,Antihypertensive Agents ,Randomized Controlled Trials as Topic ,Pulmonary Arterial Hypertension ,targeted drug ,treatment ,business.industry ,Bayes Theorem ,General Medicine ,021001 nanoscience & nanotechnology ,respiratory tract diseases ,Blood pressure ,chemistry ,Meta-analysis ,Disease Progression ,Drug Therapy, Combination ,Therapeutics. Pharmacology ,0210 nano-technology ,business ,Phosphodiesterase 5 inhibitor ,medicine.drug ,Research Article - Abstract
Background: Pulmonary arterial hypertension (PAH) is a severe and fatal clinical syndrome characterized by high blood pressure and vascular remodeling in the pulmonary arterioles, which is also a rapidly progressing disease of the lung vasculature with a poor prognosis. Although PAH medication made great advances in recent years, the efficacy and safety of the medication are unsatisfactory. Therefore, we aimed to update and expand previous studies to explore the efficacy and safety of PAH-targeted medications. Methods: Relevant articles were searched and selected from published or publicly available data in PubMed, Cochrane Library, CNKI, PsycInfo, and MEDLINE (from inception until October 1st, 2020). To assess the efficacy and safety of PAH therapies, five efficacy outcomes [6-minute walking distance (6MWD), mean pulmonary arterial pressure (mPAP), WHO functional class (WHO FC) improvement, clinical worsening, death] and two safety outcomes [adverse events (AEs), serious adverse events (SAEs)] were selected. And 6MWD was regarded as the primary efficacy outcome. Results: 50 trials included with 10 996participants were selected. In terms of efficacy, all targeted drugs were more effective than placebo. For 6MWD, Bosentan + Sildenafil, Sildenafil, Bosentan + Iloprost were better than others. Bosentan + Iloprost and Bosentan + Sildenafil were better for mPAP. Bosentan + Iloprost and Ambrisentan + Tadalafil were more effective in improving WHO FC. Bosentan + Tadalafil and Bosentan + Iloprost had the Ambrisentan probability to reduce the incidence of clinical worsening. It is demonstrated that Ambrisentan had clear benefits in reducing all-cause mortality. In terms of safety, no therapies had been shown to reduce the incidence of SAEs significantly, and Ambrisentan + Tadalafil significantly increased the incidence of AEs. Conclusions: Phosphodiesterase 5 inhibitor (PDE5i) + Endothelin Receptor Antagonists (ERA) seems to be better therapy for PAH. Prostacyclin analogs (ProsA) + ERA appear promising, though additional data is warranted. Registration PROSPERO CRD42020218818.
- Published
- 2021