Sildenafil citrate therapy for secondary pulmonary arterial hypertension due to chronic obstructive lung disease

Alkhayat, Khaled; Eid, Mohammed Mansour Abbas

doi:10.1016/j.ejcdt.2016.05.005

Cited by 4 publications

(5 citation statements)

References 17 publications

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“…Six studies (n=459) assessed effects of PDE-5i, including sildenafil (5 studies) [ 28 – 32 ] and tadalafil [ 33 ]. In five studies, PH was echo-defined using variable thresholds (sPAP >30–40 mmHg) [ 28 , 29 , 31 , 33 ], whereas a single study variably defined PH by RHC (mPAP >30–35 mmHg), depending on FEV1 1 % predicted [ 30 ].…”

Section: Resultsmentioning

confidence: 99%

“…In five studies, PH was echo-defined using variable thresholds (sPAP >30–40 mmHg) [ 28 , 29 , 31 , 33 ], whereas a single study variably defined PH by RHC (mPAP >30–35 mmHg), depending on FEV1 1 % predicted [ 30 ]. Three studies had a low risk of bias, one RCT was unclear [ 28 ], and two had a high risk of bias [ 31 , 32 ]. All five studies assessing haemodynamics reported benefits of PDE-5i.…”

Section: Resultsmentioning

confidence: 99%

“…All five studies assessing haemodynamics reported benefits of PDE-5i. Sildenafil improved echo-sPAP [ 28 , 31 ], echo-calculated mPAP [ 32 ], and RHC-mPAP [ 30 ], and tadalafil improved both echo-sPAP and calculated mPAP [ 33 ]. Pooled analyses showed favourable effects on both sPAP and mPAP ( figure 2 ).…”

Section: Resultsmentioning

confidence: 99%

“…Of six studies assessing functional capacity [ 28 – 33 ], sildenafil improved six-minute walk distance (6 MWD) in two RCTs [ 28 , 31 ] and one cohort study [ 32 ] but had no effect in two other RCTs [ 29 , 30 ]. The one study of tadalafil showed a similar lack of benefit [ 33 ].…”

Section: Resultsmentioning

confidence: 99%

“…Pooled analyses showed favourable effects on both sPAP and mPAP (Figure 2). Of 6 studies assessing functional capacity 28; 29; 30; 31; 32; 33 , sildenafil improved six-minute walk distance (6MWD) in two RCTs 28; 31 and 1 cohort study 32 , but had no effect in 2 other RCTs. 29; 30 The one study of tadalafil showed a similar lack of benefit 33 .…”

Section: Pde-5'imentioning

confidence: 99%

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Treatment of pulmonary hypertension associated with COPD: a systematic review

et al. 2021

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Chronic obstructive pulmonary disease-associated pulmonary hypertension (COPD-PH) is an increasingly recognised condition which contributes to worsening dyspnea and poor survival in COPD. It is uncertain whether specific treatment of COPD-PH, including use of medications approved for pulmonary arterial hypertension (PAH), improves clinical outcomes. This systematic review and meta-analysis assesses potential benefits and risks of therapeutic options COPD-PH.We searched Medline and Embase for relevant publications until Sep 2020. Articles were screened for studies on treatment of COPD-PH for at least 4 weeks in 10 or more patients. Screening, data extraction, and risk of bias assessment were performed independently in duplicate. When possible, relevant results were pooled using the random effects model.Supplemental long-term O2 therapy (LTOT) mildly reduced mean pulmonary artery pressure (PAP), slowed progression of PH, and reduced mortality, but other clinical or functional benefits were not assessed. Phosphodiesterase type-5 inhibitors significantly improved systolic PAP (pooled treatment effect −5.9 mmHg; 95%CI −10.3, −1.6), but had inconsistent clinical benefits. Calcium-channel blockers and endothelin receptor antagonists had limited hemodynamic, clinical, or survival benefits. Statins had limited clinical benefits despite significantly lowering systolic PAP (pooled treatment effect −4.6 mmHg; 95% CI: −6.3, −2.9).This review supports guideline recommendations for LTOT in hypoxemic COPD-PH patients as well as recommendations against treatment with PAH-targeted medications, Effective treatment of COPD-PH depends upon research into the pathobiology, and future high-quality studies comprehensively assessing clinically relevant outcomes are needed.

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