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Pulmonary Vascular Disease |

Evaluation of Gender and Racial Differences Influencing Efficacy of Therapeutics for Pulmonary Hypertension: A Meta-Regression Analysis

Elie Donath*, MD; Abubakr Chaudhry, MD; Himangi Kaushal, MD
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University of Miami, West Palm Beach, FL


Chest. 2012;142(4_MeetingAbstracts):852A. doi:10.1378/chest.1390660
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Abstract

SESSION TYPE: DVT/PE/Pulmonary Hypertension Posters II

PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM

PURPOSE: Recent meta-analyses have shown that while treatments for pulmonary hypertension (PH) have considerable efficacy, there is significant heterogeneity in their effect sizes. Investigators have attempted to identify potential contributing factors for this heterogeneity suggesting that certain sub-groups of patients might benefit more from specific treatments. A recent study in CHEST demonstrated, via pooled analysis of six studies, that women (compared to men) and whites (compared to blacks) are more likely to see greater treatment benefit from endothelin-receptor antagonists (ERA’s) in terms of 6-minute walking distance (6-MWD). We conducted a meta-regression analysis to evaluate whether this benefit extends to other classes of treatments for PH like prostacyclins and cGMP inhibitors and whether, among ERAs, we can expect to see a similar degree of efficacy when evaluating additional clinical outcomes beyond 6-MWD.

METHODS: A literature search for randomized controlled trials (RCT’s) involving PH drugs identified 11 RCT’s evaluating prostacyclins, 4 evaluating cGMP inhibitors and 9 evaluating ERA’s. Multivariate meta-regression analysis, employing a random-effects model, was performed to evaluate whether gender or race may have influenced effect size among these separate drug classes. Outcomes evaluated were 6-MWD, NYHA-HF class and mortality

RESULTS: Among trials evaluating ERA’s, an increasing proportion of females (compared to males) was correlated with improved 6-MWD (p<0.01) in treatment arms versus controls. Among trials evaluating prostacyclins, an increasing proportion of females (compared to males) was correlated with improved 6-MWD (p<0.01) and an increasing proportion of whites (compared to blacks) was correlated with improved NYHA-HF score (p=0.01) and improved 6-MWD (p=0.04) in treatment arms versus controls. Among cGMP inhibitors, neither gender nor race were associated with efficacy size.

CONCLUSIONS: Differences in effect size among PH treatments may be partly related to gender and race, as women and whites seem to derive greater benefit.

CLINICAL IMPLICATIONS: Further prospective trials are needed to evaluate the efficacy of available PH therapies in these subgroups so individual treatments can be tailored towards those that stand to benefit the most from them.

DISCLOSURE: The following authors have nothing to disclose: Elie Donath, Abubakr Chaudhry, Himangi Kaushal

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University of Miami, West Palm Beach, FL

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