Comparative Effectiveness of Sildenafil versus Tadalafil as Companion Therapy to Endothelin Receptor Antagonists in Pulmonary Hypertension: A Systematic Review and Meta-Analysis of Invasive Hemodynamic Data
Abstract
Abstract Background: Combination therapy with an endothelin receptor antagonist (ERA) and a phosphodiesterase-5 inhibitor (PDE-5i) is widely used for pulmonary arterial hypertension (PAH). While ERA/Sildenafil combinations were once common, suggestions exist that sildenafil bioavailability is reduced by ERA co-administration. This systematic review aimed to compare the effectiveness of ERA/Sildenafil versus ERA/Tadalafil in treating PAH by analyzing invasive hemodynamic data. Methodology: A comprehensive literature search was conducted using keywords (ERA, Sildenafil, Tadalafil, PAH) in PubMed, Embase, Clarivate Analytics/Web of Science Core Collection, and Wiley/Cochrane Library. The search included clinical trials and observational studies published up to July 2024, comparing ERA/Sildenafil and ERA/Tadalafil regimens reporting invasive hemodynamic measurements (mean pulmonary artery pressure [mPAP] and pulmonary vascular resistance [PVR]). A meta-analysis was performed using Julius Artificial intelligence software (applying Python tools in data analysis) to assess statistical significance in PVR and mPAP between the two groups. Results: Two retrospective studies were included, comprising 160 patients in the ERA/Sildenafil regimen and 62 in the ERA/Tadalafil regimen. The mPAP was significantly lower in the ERA/Tadalafil group ( P < 0.001), while a lower PVR was observed in the same group, though achieving less statistical significance ( P = 0.04). Conclusion: This…
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: 160 participants or records.
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