A meta‐analysis of randomized controlled trials in targeted treatments of chronic thromboembolic pulmonary hypertension

Zhang, Jing; Li, Jing-Meng; Huang, Zan-Sheng; Xu, Jiancheng; Fan, Yu

doi:10.1111/crj.13034

Cited by 3 publications

(3 citation statements)

References 57 publications

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“…The results indicated that riociguat could markedly improve the levels of hemodynamic parameters, except for PCWP and RAP. In a previous meta-analysis, the results indicated that targeted therapies could remarkably enhance pulmonary hemodynamics in patients with CTEPH [24] . Other study demonstrated that riociguat obviously decreased mean pulmonary arterial pressure (47.3– 38.9 mmHg) and PVR (9.2– 5.7 wood units), and increased cardiac index [25] .…”

Section: Discussionmentioning

confidence: 93%

“…In a previous meta-analysis, the results indicated that targeted therapies could remarkably enhance pulmonary hemodynamics in patients with CTEPH. [ 24 ] Other study demonstrated that riociguat obviously decreased mean pulmonary arterial pressure (47.3– 38.9 mmHg) and PVR (9.2– 5.7 wood units), and increased cardiac index. [ 25 ] Later, the study evaluated the effects of riociguat on hemodynamic parameters in Asian patients with inoperable CTEPH, and the results indicated that riociguat significantly reduced PAP (41– 38 mmHg) and PVR (787 to 478 dyn s cm −5 ), and relieved clinical symptoms.…”

Section: Discussionmentioning

confidence: 99%

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Efficacy and safety of riociguat in the treatment of chronic thromboembolic pulmonary arterial hypertension

Ying¹,

Song²,

Gu³

et al. 2021

Medicine

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Background: Riociguat is a novel soluble guanylate cyclase stimulator, and has been widely used for the treatment of pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension (CTEPH). Some studies found that riociguat had better effects on CTEPH and proved to be safe, but the results were not utterly consistent. Therefore, the purpose of this study was to comprehensively evaluate the efficacy and safety of riociguat in the treatment of CTEPH. Methods: Randomized controlled trials on riociguat for the treatment of CTEPH were searched through such electronic databases as PubMed, Embase, Cochrane Library, Web of Science, China national knowledge internet, and Wanfang. The outcomes included exercise capacity, pulmonary hemodynamics, and side effects. The fixed-effects or random-effects models were used to analyze the pooled data, and heterogeneity was assessed by the I 2 test. Results: Four studies involving 520 patients were included in this meta-analysis. Compared with the placebo group, riociguat significantly improved the hemodynamic indexes and increased 6-min walking distance ( P < .0001, standardized mean difference (SMD) = −0.24, 95%CI −0.35 to −0.12; P < .00001, SMD = 0.52, 95%CI 0.33 to 0.71), and decreased the Borg dyspnea score ( P = .002, SMD = −0.31, 95%CI −0.51 to −0.12). In addition, riociguat could also significantly reduce the living with pulmonary hypertension scores and increase the EQ-5D scores ( P = .01, SMD=−0.23, 95%CI −0.42 to −0.05; P < .00001, SMD = 0.47, 95%CI 0.27 to 0.66), but there was no significant difference in the change level of N-terminal pro-hormone B-type natriuretic peptide in patients with riociguat ( P = .20, SMD = −0.24, 95%CI −0.61 to −0.13). The common adverse events of riociguat were dyspepsia and peripheral edema, and no other serious adverse reactions were observed. Conclusions: We confirmed that riociguat had better therapeutic effects in improving the hemodynamic parameters and exercise capacity in patients with CTEPH without inducing serious adverse events. This will provide a reasonable medication regimen for the treatment of CTEPH.

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of riociguat in the treatment of chronic thromboembolic pulmonary arterial hypertension

Ying¹,

Song²,

Gu³

et al. 2021

Medicine

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“…Although randomized controlled trials (RCTs) [ 8 – 15 ], and a previous traditional meta-analysis [ 16 ], have compared individual drugs to placebo or conventional therapy, evidence regarding the most optimized treatment, and comparing different PAH-specific medications with each other in terms of efficacy and safety, is very limited. The previous meta-analysis only revealed that PAH‐targeted therapies are associated with positive advantages in certain outcomes when compared with placebo for patients with CTEPH [ 16 ]. Both the number of RCTs included in the previous meta-analysis and the number of outcomes described were smaller than in our current analysis featuring network meta-analysis (NMA).…”

Section: Introductionmentioning

confidence: 99%

Comparative Efficacy and Safety of Targeted Therapies for Chronic Thromboembolic Pulmonary Hypertension: A Systematic Review and Network Meta-Analysis

Chen

Fang

Luo

et al. 2021

Canadian Respiratory Journal

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Background. There is significant controversy relating to whether chronic thromboembolic pulmonary hypertension (CTEPH) can be treated with pulmonary arterial hypertension- (PAH-) targeted therapies and which therapy is the optimal choice for patients. A large number of randomized controlled trials (RCTs) have compared PAH-targeted therapies with placebo or conventional therapies. In this study, we aimed to compare all of the PAH-targeted medications that are used to treat CTEPH and rank their efficacy by the application of network meta-analysis (NMA). Methods. We searched PubMed, EMBASE, Web of Science, the Cochrane Central Register, https://clinicaltrials.gov, and who.int/trialsearch/, for relevant RCTs published up to January 2020. In addition to traditional meta-analysis, we also performed NMA in our systematic review, as deployed in a previous protocol (PROSPERO: CRD42020173765). Results. Our study identified eight eligible RCTs that evaluated seven PAH-targeted therapies in 703 patients with CTEPH. NMA revealed that riociguat was ranked first as the most optimized therapy for ameliorating the 6-minute walk distance with a probability of 80.4%. Bosentan was significantly better than others with regard to reducing brain natriuretic peptide/N-terminal pro-B-type natriuretic peptide with a probability of 84.3%. Sildenafil was identified as the best drug in terms of improving the New York Heart Association/World Health Organization functional class with a probability of 87.3%. Treprostinil and macitentan were more beneficial than other drugs in reducing pulmonary vascular resistance and lowering the incidence of clinical worsening with probabilities of 86.2% and 79.2%, respectively. Conclusion. Analysis revealed positive advantages for the use of PAH-targeted drugs in patients with CTEPH. Overall, treprostinil and riociguat were superior to all other PAH-targeted medications in most of the outcomes investigated.

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Brazilian Thoracic Society recommendations for the diagnosis and treatment of chronic thromboembolic pulmonary hypertension

Fernandes¹,

Ota-Arakaki²,

Campos³

et al. 2020

J Bras Pneumol.

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Chronic thromboembolic pulmonary hypertension (CTEPH) is a serious and debilitating disease caused by occlusion of the pulmonary arterial bed by hematic emboli and by the resulting fibrous material. Such occlusion increases vascular resistance and, consequently, the pressure in the region of the pulmonary artery, which is the definition of pulmonary hypertension. The increased load imposed on the right ventricle leads to its progressive dysfunction and, finally, to death. However, CTEPH has a highly significant feature that distinguishes it from other forms of pulmonary hypertension: the fact that it can be cured through treatment with pulmonary thromboendarterectomy. Therefore, the primary objective of the management of CTEPH should be the assessment of patient fitness for surgery at a referral center, given that not all patients are good candidates. For the patients who are not good candidates for pulmonary thromboendarterectomy, the viable therapeutic alternatives include pulmonary artery angioplasty and pharmacological treatment. In these recommendations, the pathophysiological bases for the onset of CTEPH, such as acute pulmonary embolism and the clinical condition of the patient, will be discussed, as will the diagnostic algorithm to be followed and the therapeutic alternatives currently available.

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A meta‐analysis of randomized controlled trials in targeted treatments of chronic thromboembolic pulmonary hypertension

Cited by 3 publications

References 57 publications

Efficacy and safety of riociguat in the treatment of chronic thromboembolic pulmonary arterial hypertension

Efficacy and safety of riociguat in the treatment of chronic thromboembolic pulmonary arterial hypertension

Comparative Efficacy and Safety of Targeted Therapies for Chronic Thromboembolic Pulmonary Hypertension: A Systematic Review and Network Meta-Analysis

Brazilian Thoracic Society recommendations for the diagnosis and treatment of chronic thromboembolic pulmonary hypertension

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