Sildenafil for Asian Adult Patients with Pulmonary Arterial Hypertension: A Systematic Review and Meta-analysis
Abstract
Background: The prognosis of patients with untreated pulmonary arterial hypertension (PAH) has historically been poor. Previous studies have recommended that sildenafil was beneficial, but the dose varies greatly. We aimed to evaluate sildenafil effectiveness and safety in dose of 20mg/three times a day (TID) for Asian adult patients with PAH. Methods: Electronic databases (MEDLINE, Embase, Web of Science, the Cochrane Library, CBM, CNKI and Wanfang Data) from their inception to May 2020 were searched. We included all randomized controlled trials and non-randomized studies of interventions that comparing sildenafil (20mg/TID) versus placebo or symptomatic treatment for PAH Asian adults. Results: Eight studies totaling 364 participants were included. When compared to symptomatic treatment, sildenafil treated patients were more likely to walk 68.3 meters further in six-minute walk distance [mean difference (MD)=68.3 meters, 95% confidence interval (CI) 48.85 to 87.76, P＜0.00001], to achieve an improvement in systemic arterial oxygen saturation (MD=2.48%, 95% CI 1.26 to 3.71, P＜0.00001) and in score on the Borg scale of dyspnea (MD=-0.99 points, 95% CI -1.45 to -0.53, P＜0.00001). The total number of patients with WHO class III and IV also showed downtrend. When compared to placebo, sildenafil was associated with a greater reduction in the mean pulmonary artery pressure (MD=-4.13 mmHg, 95% CI -6.52 to -1.74, P=0.0007) and level of brain natriuretic peptide (MD=-86.16 pg /mL, 95%…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 364 participants or records.
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