The specific medications for pulmonary arterial hypertension at functional class III to IV: a systematic review and meta-analysis
Abstract
Purpose: To systematically evaluate the clinical efficacy and safety of targeted drugs in patients with pulmonary arterial hypertension (PAH) with cardiac function grades III-IV, and conduct a meta-analysis.
Methods: Two researchers independently searched the PubMed, EMBASE, and Cochrane Library databases for relevant studies, with the search period extending from the establishment of the databases to March 2024. Meta-analysis was performed using statistical software Review Manager 5.4. Heterogeneity among studies was analyzed using either a random-effects model or a fixed-effects model. When the I2 value was p < 0.05 was considered statistically significant.
Results: Ten randomized controlled trials (RCTs) involving 553 patients with PAH and cardiac function grades III-IV were ultimately included. Three RCTs targeted the endothelin pathway, five targeted the prostacyclin pathway, and two assessed the effects of combination therapy. Meta-analysis and subgroup analysis revealed that short-term monotherapy with bosentan significantly improved 6MWD by ~53.67 m (95% CI: [43.57, 63.77] meters, p p p = 0.04) and -1.26 (95% CI = [-2.21, -0.32], p = 0.009), respectively. Analysis of the clinical efficacy of combination therapy in PAH patients revealed that while it did not significantly improve 6MWD, cardiac function improved in ~59.1% of patients (95% CI=[38.5%, 79.6%]). Safety analysis indicated that combination targeted therapy did not significantly increase the incidence of…
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: 553 participants or records.
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