PMID- 29998831
OWN - NLM
STAT- MEDLINE
DCOM- 20190306
LR  - 20190306
IS  - 0392-856X (Print)
IS  - 0392-856X (Linking)
VI  - 36
IP  - 6
DP  - 2018 Nov-Dec
TI  - Comparison between the efficacy of combination therapy and monotherapy in 
      connective tissue disease associated pulmonary arterial hypertension: a 
      systematic review and meta-analysis.
PG  - 1095-1102
AB  - OBJECTIVES: Although the efficacy of combined treatment targeting pulmonary 
      arterial hypertension (PAH) has been suggested to be preferable, the comparative 
      efficacy of combination therapy versus monotherapy in connective tissue disease 
      (CTD)-associated PAH (CTD-PAH) remains undetermined. We performed a meta-analysis 
      regarding this topic. METHODS: The Cochrane Library, MEDLINE, PubMed, and EMBASE 
      databases were searched for randomised controlled trials (RCTs) that directly 
      compared the efficacies of combination therapy and monotherapy targeting PAH in 
      patients with CTD-PAH. The risk of the clinical worsening of PAH and changes in 
      6-minute walk distance (6MWD) were evaluated. The Mantel-Hansel method was used 
      to pool the results with a random-effects model. RESULTS: Six RCTs with 963 
      patients were included. The results of the meta-analysis showed that combination 
      therapy significantly reduced the risk of clinical worsening events by 27% 
      (pooled relative risk of 0.73, 95% confidence interval (CI) [0.60-0.89], p=0.002) 
      with no significant heterogeneity (I2=13%, Ph=0.33) and tended to increase 6MWD 
      by 21.38 m (95% CI [-20.38 to 63.14]; p=0.32; I2=58, Ph=0.09). No significant 
      heterogeneity was indicated with funnel plots. CONCLUSIONS: Combination therapy 
      targeting PAH may confer preferable therapeutic efficacy compared with 
      monotherapy in patients with CTD-PAH as evidenced by a more remarkable reduction 
      in the risk of clinical worsening and a probable improvement of exercise capacity 
      in these patients.
FAU - Pan, Jie
AU  - Pan J
AD  - Department of Rheumatology and Clinical Immunology, the First Affiliated Hospital 
      of Guangxi Medical University, Nanning, Guangxi Province, China.
FAU - Lei, Ling
AU  - Lei L
AD  - Department of Rheumatology and Clinical Immunology, the First Affiliated Hospital 
      of Guangxi Medical University, Nanning, Guangxi Province, China. 
      leiling1972@aliyun.com.
FAU - Zhao, Cheng
AU  - Zhao C
AD  - Department of Rheumatology and Clinical Immunology, the First Affiliated Hospital 
      of Guangxi Medical University, Nanning, Guangxi Province, China.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Systematic Review
DEP - 20180614
PL  - Italy
TA  - Clin Exp Rheumatol
JT  - Clinical and experimental rheumatology
JID - 8308521
RN  - 0 (Antihypertensive Agents)
SB  - IM
MH  - Antihypertensive Agents/adverse effects/*therapeutic use
MH  - Arterial Pressure/*drug effects
MH  - Connective Tissue Diseases/*complications/diagnosis/physiopathology
MH  - Drug Therapy, Combination
MH  - Exercise Tolerance/drug effects
MH  - Humans
MH  - Hypertension, Pulmonary/diagnosis/*drug therapy/etiology/physiopathology
MH  - Pulmonary Artery/*diagnostic imaging/physiopathology
MH  - Recovery of Function
MH  - Treatment Outcome
EDAT- 2018/07/13 06:00
MHDA- 2019/03/07 06:00
CRDT- 2018/07/13 06:00
PHST- 2017/11/11 00:00 [received]
PHST- 2018/03/26 00:00 [accepted]
PHST- 2018/07/13 06:00 [pubmed]
PHST- 2019/03/07 06:00 [medline]
PHST- 2018/07/13 06:00 [entrez]
AID - 12428 [pii]
PST - ppublish
SO  - Clin Exp Rheumatol. 2018 Nov-Dec;36(6):1095-1102. Epub 2018 Jun 14.