Effects of oral targeted treatments in pulmonary arterial hypertension: A systematic review and meta-analysis

作者全名："Zhu, Hui-ru; Kuang, Hong-yu; Li, Qiang; Ji, Xiao-juan"

作者地址："[Zhu, Hui-ru] Chongqing Med Univ, Natl Clin Res Ctr Child Hlth & Disorders, Dept Ultrasound, Childrens Hosp, Chongqing, Peoples R China; [Zhu, Hui-ru; Li, Qiang] Chongqing Key Lab Pediat, Key Lab Child Dev & Disorders, Minist Educ, Chongqing, Peoples R China; [Kuang, Hong-yu] Chongqing Med Univ, Dept Cardiol, Affiliated Hosp 2, Chongqing, Peoples R China; [Li, Qiang] Chongqing Med Univ, Dept Cardiol, Childrens Hosp, Chongqing, Peoples R China; [Ji, Xiao-juan] Chongqing Gen Hosp, Dept Ultrasound, Chongqing, Peoples R China"

通信作者："Ji, XJ (通讯作者)，Chongqing Gen Hosp, Dept Ultrasound, Chongqing, Peoples R China."

来源：FRONTIERS IN CARDIOVASCULAR MEDICINE

ESI学科分类：　

WOS号：WOS:000841628200001

JCR分区：Q2

影响因子：3.6

年份：2022

卷号：9

期号：　

开始页：　

结束页：　

文献类型：Review

关键词：pulmonary arterial hypertension; prostanoids; endothelin receptor antagonists; phosphodiesterase 5 inhibitors; precision therapy

摘要："Background: Although pulmonary arterial hypertension (PAH) is a fatal disease, specific drugs have been used to treat PAH. These drugs predominantly target these three pathobiological pathways: Endothelin receptor antagonist (ERA), nitric oxide (NO), and prostanoids pathways. In this review, we aimed to analyze the efficacy and safety of oral targeted treatments for PAH. Methods: The national library of medicine (MEDLINE), excerpta medica database (EMBASE), and Cochrane Central Register of Controlled Trials databases were searched. Randomized controlled trials that compared the oral targeted drugs with placebos were selected. We calculated odds ratios (ORs) with 95% confidence intervals (CIs) for variables with dichotomous outcomes, and standardized mean differences with continuous outcomes variables. Additionally, the mean of the differences for the 6-min walk distance (6MWD) was analyzed. Results: In total, 23 studies involving 7,121 patients were included in this study. These studies show that orally PAH-specific drugs could decrease the risk of clinical worsening events, with an OR of 0.55 (p < 0.001). Furthermore, these drugs could improve exercise capacity, showing a 21.74-m increase in 6MWD (95% CI: 17.53-25.95 m) and cause a greater amelioration of functional class (OR = 0.60, 95% CI: 0.47-0.76). Additionally, subgroup analysis indicated that compared with placebo, ERAs, and drugs in the NO pathway were most effective and safe, which are associated with an improvement in exercise capacity, 6MWD, and worsening events-free survival rate. Conclusion: Nitric oxide exhibited the most prominent clinical effect on exercise tolerance. However, in the subgroup analysis, oral targeted drugs of different pathways show applicability to different populations, which highlights the need for precise treatment in the clinical setting."

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