Phosphodiesterase type 5 inhibitor plus endothelin receptor antagonist compared to either alone for group 1 pulmonary arterial hypertension
Abstract
RATIONALE: Pulmonary arterial hypertension (PAH), a rare disorder, causes elevated pressure in the pulmonary arteries, leading to heart failure. Untreated PAH has a poor prognosis, emphasising the need for effective intervention. Pharmacological treatment includes pulmonary vasodilators such as endothelin receptor antagonists (ERA), prostacyclin analogues, phosphodiesterase type 5 inhibitors (PDE5i), and soluble guanylate cyclase stimulators, often used together to improve symptoms and quality of life while reducing mortality and risk of hospitalisation.
OBJECTIVES: To assess the benefits and harms of combination therapy involving a phosphodiesterase type 5 inhibitor (PDE5i) and an endothelin receptor antagonist (ERA) in adults and adolescents with group 1 pulmonary arterial hypertension (PAH) compared to either agent alone.
SEARCH METHODS: We searched Cochrane Central Register of Controlled Trials, MEDLINE, Scopus, ClinicalTrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform for randomised controlled trials (RCTs). The most recent searches were conducted on 13 March 2024.
ELIGIBILITY CRITERIA: We included published and unpublished RCTs comparing combinations of ERAs and PDE5is versus either agent alone lasting at least 12 weeks. Participants were aged 12 years or older with WHO group 1 PAH meeting specific haemodynamic criteria. We excluded cluster-, cross-over, and quasi-RCTs, and other PAH-specific medications.
OUTCOMES:…
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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: 1,807 participants or records.
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