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Influence of riociguat treatment on pulmonary arterial hypertension

A meta-analysis of randomized controlled trials

Einfluss der Riociguattherapie auf die pulmonalarterielle Hypertonie

Metaanalyse randomisierter kontrollierter Studien

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Abstract

Background

Riociguat treatment might be beneficial for pulmonary arterial hypertension. However, the results of studies to date are controversial. We conducted a systematic review and meta-analysis to explore the influence of riociguat treatment on pulmonary arterial hypertension.

Methods

The PubMed, Embase, Web of science, EBSCO, and Cochrane Library databases were systematically searched. Randomized controlled trials (RCTs) assessing the effect of riociguat treatment on pulmonary arterial hypertension were included. Two investigators independently searched articles, extracted data, and assessed the quality of included studies. This meta-analysis was performed using the random effects model.

Results

Seven RCTs were included in the meta-analysis. Compared with a control intervention in pulmonary arterial hypertension, riociguat treatment was able to substantially improve results of the six-minute walking distance (6-MWD; standardized mean difference [SMD] = 0.53; 95% CI = 0.36–0.69; p < 0.00001), EQ-5D score (SMD = 0.35; 95% CI = 0.15–0.54; p = 0.0005), and cardiac index (SMD = 0.94; 95% CI = 0.59–1.29; p < 0.00001). The Living With Pulmonary Hypertension (LPH) score (SMD = −0.33; 95% CI = −0.50–−0.17; p < 0.0001) and pulmonary vascular resistance (PVR; SMD = −0.88; 95% CI = −1.05–−0.70; p < 0.00001) were significantly reduced after riociguat treatment. There was no increase in adverse events with riociguat treatment compared with the control intervention (RR = 1.04; 95% CI = 0.98–1.09; p = 0.19).

Conclusion

Riociguat treatment for pulmonary arterial hypertension led to a significant increase in the 6‑MWD, EQ-5D score, and cardiac index, as well as a decrease in LPH score and PVR.

Zusammenfassung

Hintergrund

Die Behandlung mit Riociguat ist möglicherweise bei pulmonalarterieller Hypertonie von Vorteil. Jedoch sind die bisherigen Studienergebnisse widersprüchlich. Die Autoren erstellten eine systematische Übersichtsarbeit und Metaanalyse, um den Einfluss der Riociguattherapie auf die pulmonalarterielle Hypertonie zu ermitteln.

Methoden

Die Datenbanken PubMed, Embase, Web of science, EBSCO und der Cochrane Library wurden systematisch durchsucht. In die Auswertung aufgenommen wurden randomisierte kontrollierte Studien (RCT) zur Wirkung einer Riociguattherapie auf die pulmonalarterielle Hypertonie. Unabhängig voneinander suchten 2 der Untersucher nach Artikeln, extrahierten Daten und beurteilten die Qualität der in die Auswertung eingeschlossenen Studien. Die vorliegende Metaanalyse wurde unter Verwendung des Random-Effects-Modells durchgeführt.

Ergebnisse

In die Metaanalyse wurden 7 RCT eingeschlossen. Im Vergleich zu einer Kontrollintervention bei pulmonalarterieller Hypertonie war es mit der Riociguattherapie möglich, die Ergebnisse im 6‑min-Gehtest („six-minute walking distance“, 6‑MWD; standardisierte mittlere Differenz, SMD: 0,53; 95%-Konfidenzintervall, 95%-KI: 0,36–0,69; p < 0,00001), EuroQol Group 5‑Dimension Self-Report Questionnaire, (EQ-5D; SMD = 0,35; 95%-KI = 0,15–0,54; p = 0,0005), und beim Herzindex (SMD = 0,94; 95%-KI = 0,59–1,29; p < 0,00001) wesentlich zu verbessern. Die Werte für den Fragebogen Living With Pulmonary Hypertension (LPH; SMD = −0,33; 95%-KI = −0,50–−0,17; p < 0,0001) und für den pulmonalen Gefäßwiderstand („pulmonary vascular resistance“, PVR; SMD = −0,88; 95%-KI = −1,05–−0,70; p < 0,00001) waren nach Riociguattherapie signifikant vermindert. Es gab keine Zunahme unerwünschter Ereignisse unter Riociguattherapie im Vergleich zur Kontrollintervention (RR = 1,04; 95%-KI = 0,98–1,09; p = 0,19).

Schlussfolgerung

Die Behandlung einer pulmonalarteriellen Hypertonie mit Riociguat führte zu einer signifikanten Steigerung beim 6‑MWD, EQ-5D-Score und Herzindex sowie zu einer Abnahme des LPH-Scores und des PVR.

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  1. Department of Ultrasonic, ChongQing Traditional Chinese Medicine Hospital, No. 6, Panxi 7 branch Road, Jiangbei District, 400021, Chongqing, China

    R. Zhao & Y. Jiang

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Correspondence to Y. Jiang.

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R. Zhao and Y. Jiang declare that they have no competing interests.

This article does not contain any studies with human participants or animals performed by any of the authors.

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Zhao, R., Jiang, Y. Influence of riociguat treatment on pulmonary arterial hypertension. Herz 44, 637–643 (2019). https://doi.org/10.1007/s00059-018-4697-z

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