Comparative Efficacy and Safety of Targeted Therapies for Chronic Thromboembolic Pulmonary Hypertension: A Systematic Review and Network Meta-Analysis
Background. There is significant controversy relating to whether chronic thromboembolic pulmonary hypertension (CTEPH) can be treated with pulmonary arterial hypertension- (PAH-) targeted therapies and which therapy is the optimal choice for patients. A large number of randomized controlled trials (...
Saved in:
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2021-01-01
|
| Series: | Canadian Respiratory Journal |
| Online Access: | http://dx.doi.org/10.1155/2021/1626971 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832548840645853184 |
|---|---|
| author | Yusi Chen Fang Li Jun Luo Jingyuan Chen Peng Luo Jiang Li |
| author_facet | Yusi Chen Fang Li Jun Luo Jingyuan Chen Peng Luo Jiang Li |
| author_sort | Yusi Chen |
| collection | DOAJ |
| description | Background. There is significant controversy relating to whether chronic thromboembolic pulmonary hypertension (CTEPH) can be treated with pulmonary arterial hypertension- (PAH-) targeted therapies and which therapy is the optimal choice for patients. A large number of randomized controlled trials (RCTs) have compared PAH-targeted therapies with placebo or conventional therapies. In this study, we aimed to compare all of the PAH-targeted medications that are used to treat CTEPH and rank their efficacy by the application of network meta-analysis (NMA). Methods. We searched PubMed, EMBASE, Web of Science, the Cochrane Central Register, https://clinicaltrials.gov, and who.int/trialsearch/, for relevant RCTs published up to January 2020. In addition to traditional meta-analysis, we also performed NMA in our systematic review, as deployed in a previous protocol (PROSPERO: CRD42020173765). Results. Our study identified eight eligible RCTs that evaluated seven PAH-targeted therapies in 703 patients with CTEPH. NMA revealed that riociguat was ranked first as the most optimized therapy for ameliorating the 6-minute walk distance with a probability of 80.4%. Bosentan was significantly better than others with regard to reducing brain natriuretic peptide/N-terminal pro-B-type natriuretic peptide with a probability of 84.3%. Sildenafil was identified as the best drug in terms of improving the New York Heart Association/World Health Organization functional class with a probability of 87.3%. Treprostinil and macitentan were more beneficial than other drugs in reducing pulmonary vascular resistance and lowering the incidence of clinical worsening with probabilities of 86.2% and 79.2%, respectively. Conclusion. Analysis revealed positive advantages for the use of PAH-targeted drugs in patients with CTEPH. Overall, treprostinil and riociguat were superior to all other PAH-targeted medications in most of the outcomes investigated. |
| format | Article |
| id | doaj-art-afabcd0280a34bb8b7fd77e0cb2a4d16 |
| institution | Kabale University |
| issn | 1198-2241 1916-7245 |
| language | English |
| publishDate | 2021-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Canadian Respiratory Journal |
| spelling | doaj-art-afabcd0280a34bb8b7fd77e0cb2a4d162025-02-03T06:12:56ZengWileyCanadian Respiratory Journal1198-22411916-72452021-01-01202110.1155/2021/16269711626971Comparative Efficacy and Safety of Targeted Therapies for Chronic Thromboembolic Pulmonary Hypertension: A Systematic Review and Network Meta-AnalysisYusi Chen0Fang Li1Jun Luo2Jingyuan Chen3Peng Luo4Jiang Li5Department of Cardiology, The Second Xiangya Hospital of Central South University, No. 139 Middle Renmin Road, Furong District, Changsha, Hunan 410011, ChinaDepartment of Radiology and Imaging, Zhuzhou Central Hospital of Central South University, No. 116 Changjiang South Road, Tianyuan District, Zhuzhou, Hunan 410011, ChinaDepartment of Cardiology, The Second Xiangya Hospital of Central South University, No. 139 Middle Renmin Road, Furong District, Changsha, Hunan 410011, ChinaDepartment of Cardiology, The Second Xiangya Hospital of Central South University, No. 139 Middle Renmin Road, Furong District, Changsha, Hunan 410011, ChinaDepartment of Cardiology, The Second Xiangya Hospital of Central South University, No. 139 Middle Renmin Road, Furong District, Changsha, Hunan 410011, ChinaDepartment of Cardiology, The Second Xiangya Hospital of Central South University, No. 139 Middle Renmin Road, Furong District, Changsha, Hunan 410011, ChinaBackground. There is significant controversy relating to whether chronic thromboembolic pulmonary hypertension (CTEPH) can be treated with pulmonary arterial hypertension- (PAH-) targeted therapies and which therapy is the optimal choice for patients. A large number of randomized controlled trials (RCTs) have compared PAH-targeted therapies with placebo or conventional therapies. In this study, we aimed to compare all of the PAH-targeted medications that are used to treat CTEPH and rank their efficacy by the application of network meta-analysis (NMA). Methods. We searched PubMed, EMBASE, Web of Science, the Cochrane Central Register, https://clinicaltrials.gov, and who.int/trialsearch/, for relevant RCTs published up to January 2020. In addition to traditional meta-analysis, we also performed NMA in our systematic review, as deployed in a previous protocol (PROSPERO: CRD42020173765). Results. Our study identified eight eligible RCTs that evaluated seven PAH-targeted therapies in 703 patients with CTEPH. NMA revealed that riociguat was ranked first as the most optimized therapy for ameliorating the 6-minute walk distance with a probability of 80.4%. Bosentan was significantly better than others with regard to reducing brain natriuretic peptide/N-terminal pro-B-type natriuretic peptide with a probability of 84.3%. Sildenafil was identified as the best drug in terms of improving the New York Heart Association/World Health Organization functional class with a probability of 87.3%. Treprostinil and macitentan were more beneficial than other drugs in reducing pulmonary vascular resistance and lowering the incidence of clinical worsening with probabilities of 86.2% and 79.2%, respectively. Conclusion. Analysis revealed positive advantages for the use of PAH-targeted drugs in patients with CTEPH. Overall, treprostinil and riociguat were superior to all other PAH-targeted medications in most of the outcomes investigated.http://dx.doi.org/10.1155/2021/1626971 |
| spellingShingle | Yusi Chen Fang Li Jun Luo Jingyuan Chen Peng Luo Jiang Li Comparative Efficacy and Safety of Targeted Therapies for Chronic Thromboembolic Pulmonary Hypertension: A Systematic Review and Network Meta-Analysis Canadian Respiratory Journal |
| title | Comparative Efficacy and Safety of Targeted Therapies for Chronic Thromboembolic Pulmonary Hypertension: A Systematic Review and Network Meta-Analysis |
| title_full | Comparative Efficacy and Safety of Targeted Therapies for Chronic Thromboembolic Pulmonary Hypertension: A Systematic Review and Network Meta-Analysis |
| title_fullStr | Comparative Efficacy and Safety of Targeted Therapies for Chronic Thromboembolic Pulmonary Hypertension: A Systematic Review and Network Meta-Analysis |
| title_full_unstemmed | Comparative Efficacy and Safety of Targeted Therapies for Chronic Thromboembolic Pulmonary Hypertension: A Systematic Review and Network Meta-Analysis |
| title_short | Comparative Efficacy and Safety of Targeted Therapies for Chronic Thromboembolic Pulmonary Hypertension: A Systematic Review and Network Meta-Analysis |
| title_sort | comparative efficacy and safety of targeted therapies for chronic thromboembolic pulmonary hypertension a systematic review and network meta analysis |
| url | http://dx.doi.org/10.1155/2021/1626971 |
| work_keys_str_mv | AT yusichen comparativeefficacyandsafetyoftargetedtherapiesforchronicthromboembolicpulmonaryhypertensionasystematicreviewandnetworkmetaanalysis AT fangli comparativeefficacyandsafetyoftargetedtherapiesforchronicthromboembolicpulmonaryhypertensionasystematicreviewandnetworkmetaanalysis AT junluo comparativeefficacyandsafetyoftargetedtherapiesforchronicthromboembolicpulmonaryhypertensionasystematicreviewandnetworkmetaanalysis AT jingyuanchen comparativeefficacyandsafetyoftargetedtherapiesforchronicthromboembolicpulmonaryhypertensionasystematicreviewandnetworkmetaanalysis AT pengluo comparativeefficacyandsafetyoftargetedtherapiesforchronicthromboembolicpulmonaryhypertensionasystematicreviewandnetworkmetaanalysis AT jiangli comparativeefficacyandsafetyoftargetedtherapiesforchronicthromboembolicpulmonaryhypertensionasystematicreviewandnetworkmetaanalysis |