Effects of Phosphodiesterase-5 Inhibitors in Patients with Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis

Isa, Nafeesah; Mudhafar, Durrah; Ju, Chengsheng; Man, Kenneth K C; Lau, Wallis C.Y.; Cheng, Lok Yin; Li, Wei

doi:10.1080/15412555.2022.2067525

Cited by 6 publications

(8 citation statements)

References 29 publications

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“…As a result, heterogeneity was considered acceptable. Sensitivity analyses were conducted to assess whether the combined results would be significantly affected by a single study, and funnel plots were used to assess publication bias 8,9 …”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of macitentan for pulmonary hypertension: A meta‐analysis

Yuan

2023

Clinical Respiratory J

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IntroductionOur purpose of this study is to evaluate the effect and safety of macitentan in the treatment of pulmonary hypertension (PH).MethodsWe retrieved the safety and efficacy of macitentan treatment for PH using PubMed, the Cochrane Library, EMBASE databases and clinicaltrials.gov. The Cochrane Risk of Bias Tool was used for literature screening and quality assessment. Data analysis was conducted using RevMan 5.4.1 and Stata/SE 15.1 software. Results are presented as standardization mean differences (SMDs) and odds ratio (OR).ResultsMeta‐analysis of seven randomized controlled trial (RCT) studies and four non‐RCT studies with 2769 patients was included, involving 723 in the macitentan group and 599 in the placebo group. The results of the study showed that macitentan had effectively decreased pulmonary vascular resistance (PVR) (SMD = −0.53, 95% CI: −0.77–−0.29, p < 0.05), cardiac index (CI) (SMD = 0.60, 95% CI: 0.37–0.83, p < 0.05) and N‐terminal pro‐brain natriuretic peptide (NT‐proBNP) (SMD = −0.22, 95% CI: −0.40–−0.03, p < 0.05). Furthermore, macitentan also significantly reduced PVR (SMD = −0.58, 95% CI: −0.80–−0.35, p < 0.05), 6‐min walk distance (6WMD) (SMD = 0.33, 95% CI: 0.15–0.50, p < 0.05), CI (SMD = 0.48, 95% CI: 0.28–0.69, p < 0.05), mean pulmonary arterial pressure (mPAP) (SMD = −0.43, 95% CI: −0.64–−0.23, p < 0.05) and NT‐proBNP (SMD = −0.55, 95% CI: −1.07–−0.03, p < 0.05) between baseline and follow‐up. The adverse reactions to macitentan were mild, with headache, anaemia and bronchitis. Other efficacy and safety outcomes did not reach statistical differences.ConclusionMacitentan therapy for PH is effective and safe. The effectiveness on PVR, mPAP, mean right atrial pressure (mRAP), mortality and other indicators still needs to be further confirmed.

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Section: Discussionmentioning

confidence: 99%

Efficacy and safety of macitentan for pulmonary hypertension: A meta‐analysis

Yuan

2023

Clinical Respiratory J

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“…Currently, only treatment of COPD itself and correction of hypoxemia with long-term oxygen therapy are recommended for PH-COPD. Recent meta-analyses include inhaled prostacyclin agents [22] and PDE-5 inhibitors [23] that showed no improvement in functional capacity or 6MWD for PH-COPD. However, three studies assessing the effects of sildenafil on pulmonary hemodynamics showed significant reductions in the pooled mPAP (À3.83 mmHg [23]).…”

Section: Pulmonary Hypertension In Chronic Obstructive Pulmonary Dise...mentioning

confidence: 99%

“…Recent meta-analyses include inhaled prostacyclin agents [22] and PDE-5 inhibitors [23] that showed no improvement in functional capacity or 6MWD for PH-COPD. However, three studies assessing the effects of sildenafil on pulmonary hemodynamics showed significant reductions in the pooled mPAP (À3.83 mmHg [23]). Likewise, a separate meta-analysis that included sildenafil and bosentan in PH-COPD again demonstrated significant improvements in mPAP and PVR with treatment [23].…”

Section: Pulmonary Hypertension In Chronic Obstructive Pulmonary Dise...mentioning

confidence: 99%

“…However, three studies assessing the effects of sildenafil on pulmonary hemodynamics showed significant reductions in the pooled mPAP (À3.83 mmHg [23]). Likewise, a separate meta-analysis that included sildenafil and bosentan in PH-COPD again demonstrated significant improvements in mPAP and PVR with treatment [23]. If these results are interpreted in conjunction with the results from the COMPERA registry study in severe PH-COPD patients [11], there appears to be a subset of PH-COPD patients that may benefit from PAH treatment.…”

Section: Pulmonary Hypertension In Chronic Obstructive Pulmonary Dise...mentioning

confidence: 99%

“…Many of the recent studies investigating PAH therapies in PH-COPD are meta-analyses of small clinical trials that unfortunately highlight the relative dearth of high-quality studies in this arena and failed to show significant benefits [21 ▪▪ ,22,23]. Currently, only treatment of COPD itself and correction of hypoxemia with long-term oxygen therapy are recommended for PH-COPD.…”

Section: Knowledge Gaps and Future Directionsmentioning

confidence: 99%

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Pulmonary hypertension in chronic obstructive pulmonary disease: current understanding, knowledge gaps and future directions

Atchley,

Kakkera

2023

Current Opinion in Pulmonary Medicine

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Purpose of review Despite the advent of effective and mechanistically diverse treatments for pulmonary arterial hypertension (PAH) and their positive impacts on the functional capacities and outcomes for PAH patients, the much larger population of patients with pulmonary hypertension (PH) in chronic lung diseases like chronic obstructive pulmonary disease (PH-COPD) remain without effective therapies. Recent findings In this review, we will highlight advances in the understanding of PH-COPD pathobiology, the clinical impact comorbid PH has on COPD outcomes, and detail the spectrum of disease and clinical phenotypes that encompass the heterogenous disease manifestations of PH-COPD. Finally, we will examine recent studies exploring the effects of potential treatments for PH-COPD and highlight sub-populations and treatment options that warrant further study. Summary As the PAH population-base ages and comorbid diseases become more frequently diagnosed in PAH patients, the need to clearly delineate subpopulations for clinical applications of PH therapies and research becomes even more urgent. Through an improved understanding of the clinical phenotypes of PH-COPD and the overlap with certain subpopulations of PAH, a framework for future research and potential for therapeutic impact is highlighted.

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