Efficacy and safety of riociguat replacing PDE-5is for patients with pulmonary arterial hypertension: A systematic review and meta-analysis

Frontiers in Pharmacology

Pharmacology

Rui Zhang¹  Hong-Ling Qiu²  Shang Wang²  Yi-Yang Qu²  Hui-Ting Li²  Ci-Jun Luo²  Ping Yuan²  Rong Jiang²  Lan Wang²  Yu-Yang Liu²  Jin-Ling Li³ 

[1] Department of Cardiology, Affiliated Hospital of Qingdao University, Qingdao, China;Department of Cardiopulmonary Circulation, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China;Department of Cardiopulmonary Circulation, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China;Department of Cardiology, Affiliated Hospital of Qingdao University, Qingdao, China;

关键词: pulmonary arterial hypertension;    riociguat;    systematic review;    meta;    analysis;    phosphodiesterase-5 inhibitor;   

DOI  :  10.3389/fphar.2023.1052546

 received in 2022-09-24, accepted in 2023-01-11,  发布年份 2023

来源: Frontiers

【 摘 要 】

Introduction: Pulmonary arterial hypertension (PAH) is a rare and progressive disease. Some patients treated with phosphodiesterase type 5 inhibitors (PDE-5is) fail to reach treatment goals. As a novel soluble guanylate cyclase agonist, riociguat acts on the same pathway as PDE-5is but functions via different mechanisms. Whether riociguat is more effective and safer than PDE-5is is ambiguous. We aimed to evaluate the efficacy and safety of switching from PDE-5is to riociguat among these patients.Methods: Original published articles were retrieved from PubMed/Medline, Embase, Web of Science, Open Grey and Google Scholar. Studies that assessed the World Health Organization functional class (WHO-FC), 6-min walking distance (6MWD), pulmonary vascular resistance (PVR), mean pulmonary arterial pressure (mPAP), cardiac index (CI) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) were collected. Adverse events after switching were evaluated.Results: Ten published studies were included. Compared to PDE-5is, riociguat significantly increased the 6MWD by 26.45 m weighted mean difference (WMD) = 26.45 m, 95% confidence intervals (CIs): 9.70–43.2 m, p = 0.002) and improved mPAP (WMD = −3.53, 95% CIs: −5.62–1.44 mmHg, p = 0.0009), PVR (WMD = −130.24 dyn·s·cm−5, 95% CI −187.43–73.05, p < 0.0001), CIs (WMD = 0.36 L/min·cm−2, 95% CIs: 0.25–0.47, p < 0.00001) and WHO-FC (OR = 0.11, 95% CIs: 0.08–0.16, p < 0.0001) but not NT-proBNP. In addition, we did not observe the most common side effects during the replacement of riociguat for PDE-5is.Conclusions: Compared to PDE5i, PAH patients benefit more from riociguat in hemodynamics, 6MWD, WHO-FC and biomarkers.

【 授权许可】

Unknown   
Copyright © 2023 Liu, Qu, Wang, Luo, Qiu, Li, Yuan, Wang, Li, Jiang and Zhang.