Efficacy of Riociguat on pulmonary hypertension: a systematic review and meta-analysis

Aims: Riociguat might be a promising approach to treat pulmonary hypertension. However, the results have been controversial. Therefore, we conducted a systematic review and meta-analysis to explore the efficacy of Riociguat for patients with pulmonary hypertension. Methods: PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases were systematically searched. Randomized controlled trials (RCTs) assessing the effect of Riociguat versus placebo on pulmonary hypertension were included. Two investigators independently searched articles, extracted data, and assessed the quality of included studies. The primary outcomes were the change in 6-min walking distance and EQ-5D score. Meta-analysis was performed using the random-effect model. Results: Five RCTs involving 627 patients were included in the meta-analysis. Overall, compared with control intervention in pulmonary hypertension, Riociguat intervention was found to significantly increase 6-min walking distance (Mean difference (MD) = 44.63; 95% CI = 25.55 - 63.71; P<0.00001), EQ-5D score (MD = 0.14; 95% CI = 0.07 - 0.21; P = 0.0002), cardiac index (MD = 0.58; 95% CI = 0.40 - 0.27; P = 0.76), and reduce PVR (MD = -281.66; 95% CI = -369.72 - -193.60; P<0.00001), NT-proBNP (MD = -447.16; 95% CI = -838.64 - -55.69; P = 0.03), with no increase in adverse events (RR = 1.03; 95% CI = 0.95 - 1.12; P = 0.43). Conclusions: Compared to control intervention for pulmonary hypertension, Riociguat intervention was found to significantly improve 6-min walking distance, EQ-5D score, and cardiac index, as well as reduce PVR and NT-proBNP, without an increase in adverse events.