Department of Respiratory Medicine, The First Hospital of Jilin University, Changchun 130021, Jilin, China.
Department of Hepatobiliary Surgery, The First Hospital of Jilin University, Changchun 130021, Jilin, China.
Pulm Pharmacol Ther. 2018 Jun;50:1-10. doi: 10.1016/j.pupt.2017.11.002. Epub 2017 Nov 8.
This network meta-analysis (NMA) is designed to compare the efficacy and tolerability of various therapies and combinations for pulmonary arterial hypertension (PAH).
We conducted a systematic search in databases PubMed, Embase, and Cochrane Library. Treatment efficacy and tolerability were compared by synthesizing direct and indirect evidence. The surface under the curve ranking area was utilized to rank multiple interventions.
A total of 43 randomized clinical trials were included in our NMA. With regard to efficacy outcomes, including 6 min walking distance (6MWD), functional class amelioration (FCA), death, clinical worsening (CW), pulmonary vascular resistance (PVR), mean pulmonary artery pressure (mPAP), cardiac index (CI), and mean right atrial pressure (mRAP), endothelin receptor antagonists (ERA), phosphodiesterase 5 inhibitor (PDE-5Is), ERA combined with PDE-5Is (EAP), and prostacyclin analogs (PGI) combined with ERA (PAE) performed better than others. Meanwhile PAP and PGE demonstrated better than others in tolerability. Overall, EAP and PAE showed good efficacy and were well-tolerated among all therapies.
Overall, we recommend EAP as the optimal choice for patients with PAH in clinical practice and PAE as suboptimal in view of their desirable performance in efficacy. Most of the combination therapies performed better than monotherapies.
本网络荟萃分析（NMA）旨在比较各种治疗方法和联合用药治疗肺动脉高压（PAH）的疗效和耐受性。
我们在 PubMed、Embase 和 Cochrane Library 数据库中进行了系统检索。通过综合直接和间接证据比较治疗效果和耐受性。利用曲线下面积排名来对多种干预措施进行排名。
我们的 NMA 共纳入 43 项随机临床试验。在疗效结局方面，包括 6 分钟步行距离（6MWD）、功能改善（FCA）、死亡、临床恶化（CW）、肺血管阻力（PVR）、平均肺动脉压（mPAP）、心指数（CI）和平均右心房压（mRAP），内皮素受体拮抗剂（ERA）、磷酸二酯酶 5 抑制剂（PDE-5Is）、ERA 联合 PDE-5Is（EAP）和前列环素类似物（PGI）联合 ERA（PAE）的疗效优于其他药物。同时，PAP 和 PGE 在耐受性方面表现优于其他药物。总的来说，EAP 和 PAE 在所有治疗方法中表现出良好的疗效和耐受性。
总体而言，我们建议在临床实践中，EAP 是治疗 PAH 的最佳选择，而 PAE 是次优选择，因为它们在疗效方面表现理想。大多数联合治疗方法比单一治疗方法表现更好。
