Comparative Effectiveness and Safety of Drug Therapy for Pulmonary Arterial Hypertension A Systematic Review and Meta-analysis

被引:41
作者
Coeytaux, Remy R. [1 ,4 ]
Schmit, Kristine M. [1 ]
Kraft, Bryan D. [2 ]
Kosinski, Andrzej S. [3 ]
Mingo, Alicea M. [5 ]
Vann, Lisa M. [6 ]
Gilstrap, Daniel L. [2 ]
Hargett, William [2 ]
Heidenfelder, Brooke [4 ]
Dolor, Rowena J. [4 ,7 ,8 ]
McCrory, Douglas C. [4 ,7 ,8 ]
机构
[1] Duke Univ, Sch Med, Dept Community & Family Med, Durham, NC USA
[2] Duke Univ, Sch Med, Div Pulm Med, Durham, NC USA
[3] Duke Univ, Sch Med, Dept Biostat & Bioinformat, Durham, NC USA
[4] Duke Univ, Duke Clin Res Inst, Duke Evidence Based Practice Ctr, Durham, NC USA
[5] United States Navy, Durham, NC USA
[6] Duke Univ, Med Ctr, Div Hosp Med, Durham, NC USA
[7] Duke Univ, Med Ctr, Div Gen Internal Med, Dept Med, Durham, NC 27710 USA
[8] Dept Vet Affairs, Ctr Hlth Serv Res Primary Care, Durham, NC USA
基金
美国医疗保健研究与质量局;
关键词
CONTINUOUS INTRAVENOUS EPOPROSTENOL; ENDOTHELIN-RECEPTOR ANTAGONIST; DOUBLE-BLIND; INHALED ILOPROST; CONTROLLED-TRIAL; EISENMENGER-SYNDROME; SILDENAFIL CITRATE; BOSENTAN THERAPY; RANDOMIZED-TRIAL; TREPROSTINIL;
D O I
10.1378/chest.13-1864
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Background: Current treatments for pulmonary arterial hypertension (PAH) have been shown to improve dyspnea, 6-min walk distance (6MWD), and pulmonary hemodynamics, but few studies were designed to compare treatment regimens or assess the impact of treatment on mortality. Methods: We conducted a systematic review to evaluate the comparative effectiveness and safety of monotherapy or combination therapy for PAH using endothelin receptor antagonists, phosphodiesterase inhibitors, or prostanoids. We searched English-language publications of comparative studies that reported intermediate or long-term outcomes associated with drug therapy for PAH. Two investigators abstracted data and rated study quality and applicability. Results: We identified 28 randomized controlled trials involving 3,613 patients. We found no studies that randomized treatment-naive patients to monotherapy vs combination therapy. There was insufficient statistical power to detect a mortality difference associated with treatment. All drug classes demonstrated increases in 6MWD when compared with placebo, and combination therapy showed improved 6MWD compared with monotherapy. For hospitalization, the OR was lower in patients taking endothelin receptor antagonists or phosphodiesterase-5 inhibitors compared with placebo (OR, 0.34 and 0.48, respectively). Conclusions: Although no studies were powered to detect a mortality reduction, monotherapy was associated with improved 6MWD and reduced hospitalization rates. Our findings also suggest an improvement in 6MWD when a second drug is added to monotherapy.
引用
收藏
页码:1055 / 1063
页数:9
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