PMID- 28507431
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20200930
IS  - 1177-889X (Print)
IS  - 1177-889X (Electronic)
IS  - 1177-889X (Linking)
VI  - 11
DP  - 2017
TI  - Targeted drugs for pulmonary arterial hypertension: a network meta-analysis of 32 
      randomized clinical trials.
PG  - 871-885
LID - 10.2147/PPA.S133288 [doi]
AB  - BACKGROUND: Pulmonary arterial hypertension (PAH) is a devastating disease and 
      ultimately leads to right heart failure and premature death. A total of four 
      classical targeted drugs, prostanoids, endothelin receptor antagonists (ERAs), 
      phosphodiesterase 5 inhibitors (PDE-5Is), and soluble guanylate cyclase 
      stimulator (sGCS), have been proved to improve exercise capacity and hemodynamics 
      compared to placebo; however, direct head-to-head comparisons of these drugs are 
      lacking. This network meta-analysis was conducted to comprehensively compare the 
      efficacy of these targeted drugs for PAH. METHODS: Medline, the Cochrane Library, 
      and other Internet sources were searched for randomized clinical trials exploring 
      the efficacy of targeted drugs for patients with PAH. The primary effective end 
      point of this network meta-analysis was a 6-minute walk distance (6MWD). RESULTS: 
      Thirty-two eligible trials including 6,758 patients were identified. There was a 
      statistically significant improvement in 6MWD, mean pulmonary arterial pressure, 
      pulmonary vascular resistance, and clinical worsening events associated with each 
      of the four targeted drugs compared with placebo. Combination therapy improved 
      6MWD by 20.94 m (95% confidence interval [CI]: 6.94, 34.94; P=0.003) vs 
      prostanoids, and 16.94 m (95% CI: 4.41, 29.47; P=0.008) vs ERAs. PDE-5Is improved 
      6MWD by 17.28 m (95% CI: 1.91, 32.65; P=0.028) vs prostanoids, with a similar 
      result with combination therapy. In addition, combination therapy reduced mean 
      pulmonary artery pressure by 3.97 mmHg (95% CI: -6.06, -1.88; P<0.001) vs 
      prostanoids, 8.24 mmHg (95% CI: -10.71, -5.76; P<0.001) vs ERAs, 3.38 mmHg (95% 
      CI: -6.30, -0.47; P=0.023) vs PDE-5Is, and 3.94 mmHg (95% CI: -6.99, -0.88; 
      P=0.012) vs sGCS. There were no significant differences in all-cause mortality 
      and severe adverse events between prostanoids, ERAs, PDE-5Is, sGCS, combination 
      therapy, and placebo. CONCLUSION: All targeted drugs for PAH are associated with 
      improved clinical outcomes, especially combination therapy. However, all these 
      drugs seem to show less favorable effects on survival in the short-term 
      follow-up, suggesting further clinical trials are required.
FAU - Gao, Xiao-Fei
AU  - Gao XF
AD  - Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, 
      Nanjing.
FAU - Zhang, Jun-Jie
AU  - Zhang JJ
AD  - Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, 
      Nanjing.
AD  - Department of Cardiology, Nanjing Heart Center, Nanjing, People's Republic of 
      China.
FAU - Jiang, Xiao-Min
AU  - Jiang XM
AD  - Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, 
      Nanjing.
FAU - Ge, Zhen
AU  - Ge Z
AD  - Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, 
      Nanjing.
AD  - Department of Cardiology, Nanjing Heart Center, Nanjing, People's Republic of 
      China.
FAU - Wang, Zhi-Mei
AU  - Wang ZM
AD  - Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, 
      Nanjing.
FAU - Li, Bing
AU  - Li B
AD  - Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, 
      Nanjing.
FAU - Mao, Wen-Xing
AU  - Mao WX
AD  - Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, 
      Nanjing.
FAU - Chen, Shao-Liang
AU  - Chen SL
AD  - Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, 
      Nanjing.
AD  - Department of Cardiology, Nanjing Heart Center, Nanjing, People's Republic of 
      China.
LA  - eng
PT  - Journal Article
DEP - 20170508
PL  - New Zealand
TA  - Patient Prefer Adherence
JT  - Patient preference and adherence
JID - 101475748
PMC - PMC5428768
OTO - NOTNLM
OT  - 6-minute walk distance
OT  - network meta-analysis
OT  - prostanoids
OT  - pulmonary arterial hypertension
OT  - targeted drugs
COIS- Disclosure The authors report no conflicts of interest in this work.
EDAT- 2017/05/17 06:00
MHDA- 2017/05/17 06:01
PMCR- 2017/05/08
CRDT- 2017/05/17 06:00
PHST- 2017/05/17 06:00 [entrez]
PHST- 2017/05/17 06:00 [pubmed]
PHST- 2017/05/17 06:01 [medline]
PHST- 2017/05/08 00:00 [pmc-release]
AID - ppa-11-871 [pii]
AID - 10.2147/PPA.S133288 [doi]
PST - epublish
SO  - Patient Prefer Adherence. 2017 May 8;11:871-885. doi: 10.2147/PPA.S133288. 
      eCollection 2017.