Zheng Xiaoyu, Zheng Weijin, Xiong Bo, Huang Jing
Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Medicine (Baltimore). 2018 Oct;97(41):e12709. doi: 10.1097/MD.0000000000012709.
Several randomized controlled trials (RCTs) have been investigated the benefits of soluble guanylate cyclase (sGC) stimulators in the treatment of heart failure, but a comprehensive evaluation is lacking. We performed a meta-analysis to evaluate the efficacy and safety of oral sGC stimulators (vericiguat and riociguat) in patients with heart failure.
Studies were searched and screened in PubMed, Embase, and Cochrane Library. Eligible RCTs were included that reported mortality, the change of EuroQol Group 5-Dmensional Self-report Questionnaire (EQ-5D) US index, N-terminal pro-B-type natriuretic peptide (NT-proBNP), or serious adverse events (SAEs). Relative risk or weight mean difference (WMD) was estimated using fixed effect model or random effect model. Analysis of sensitivity and publication bias was conducted.
Five trials with a total of 1200 patients were included. sGC stimulators had no impact on the mortality (1.25; 95% confidence interval 0.50-3.11) and significantly improved EQ-5D US index (0.04; 95% confidence interval 0.020-0.05). Furthermore, in comparison with control group, NT-proBNP was statistically decreased in riociguat group (-0.78; 95% confidence interval -1.01 to -0.47), but not in vericiguat group (0.04, 95% confidence interval -0.18 to 0.25). There were not obverse differences in SAEs between sGC stimulators and control groups (0.90; 95% confidence interval 0.72-1.12).
Our meta-analysis suggests that sGC stimulators could improve the quality of life in patients with heart failure with good tolerance and safety, but their long-term benefits need to be observed in the future. sGC stimulators are likely to be promising add-on strategies for the treatment of heart failure.
多项随机对照试验（RCT）已对可溶性鸟苷酸环化酶（sGC）刺激剂在治疗心力衰竭中的益处进行了研究，但缺乏全面评估。我们进行了一项荟萃分析，以评估口服sGC刺激剂（维立西呱和利奥西呱）在心力衰竭患者中的疗效和安全性。
在PubMed、Embase和Cochrane图书馆中检索和筛选研究。纳入符合条件的RCT，这些研究报告了死亡率、欧洲五维健康量表（EQ-5D）美国指数的变化、N末端B型利钠肽原（NT-proBNP）或严重不良事件（SAE）。使用固定效应模型或随机效应模型估计相对风险或加权平均差（WMD）。进行敏感性分析和发表偏倚分析。
纳入了5项试验，共1200例患者。sGC刺激剂对死亡率无影响（1.25；95%置信区间0.50 - 3.11），并显著改善了EQ-5D美国指数（0.04；95%置信区间0.020 - 0.05）。此外，与对照组相比，利奥西呱组的NT-proBNP有统计学意义的降低（-0.78；95%置信区间-1.01至-0.47），但维立西呱组无降低（0.04，95%置信区间-0.18至0.25）。sGC刺激剂与对照组之间的SAE无明显差异（0.90；95%置信区间0.72 - 1.12）。
我们的荟萃分析表明，sGC刺激剂可改善心力衰竭患者的生活质量，耐受性和安全性良好，但其长期益处有待未来观察。sGC刺激剂可能是治疗心力衰竭的有前景的附加策略。
