Pulmonary Vascular Disease |

Riociguat for the Treatment of Pulmonary Hypertension: A Meta-analysis of Randomized Controlled Trials FREE TO VIEW

Abdulah Alrifai, MD; Brian Garnet, MD; Varun Shah, MD; Louis Lit, MD
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University of Miami, West palm beach, FL

Chest. 2015;148(4_MeetingAbstracts):951A. doi:10.1378/chest.2281793
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SESSION TITLE: Pulmonary Arterial Hypertension Posters II

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: Several recent clinical trials have showed that Riociguat, a member of a novel class of medications, soluble guanylate cyclase activators, has beneficial effects in both clinical and hemodynamic outcomes patients with differing etiologies of pulmonary artery hypertension (PAH). We sought to determine whether these outcomes were generalizable across groups.

METHODS: We searched Pubmed, Medline, Embase and Cochrane for prospective RCTs that compared Riociguat to placebo in patients with PAH. Trials that included patients with PAH regardless of etiology randomized to Riociguat or placebo were included. Mantel Haenszel relative risk and mean difference were calculated using the fixed or random effect model based on heterogeneity.

RESULTS: Data from 3 randomized, placebo controlled trials of Riociguat in patients with PAH resulted in 283 patients. For the primary outcome, 6 minute walk distance, Riociguat was associated with a significant increase compared to placebo (mean difference 37.2 m; 95% CI 24.5-49.9 m; p<0.001). A quality of life score, the EQ-SD also had a significant increase compared to placebo (mean difference 0.08; 95% CI 0.04-0.13; p<0.001). Analysis of hemodynamic variables revealed a significant decrease in pulmonary artery pressure in the Riociguat group (mean difference -3.95 mm Hg; 95% CI -5.26- -2.64 mm Hg; p<0.001), while pulmonary capillary wedge pressure was not significantly different (mean difference 0.35 mm Hg; 95% CI 0.38-1.08 mm Hg; p=0.35). Our analysis also showed a significant decrease in dyspnea in the Riociguat group (OR 0.46; 95% CI 0.26-0.81; p=0.007), but no difference in adverse events (OR 1.02; 95% CI 0.93-1.12; p=0.67), or mortality (OR 0.65; 95% CI 0.20-2.11; p=0.47).

CONCLUSIONS: Riociguat significantly improves exercise tolerance in patients with both primary and secondary PAH through an apparent direct effect on pulmonary artery pressure.

CLINICAL IMPLICATIONS: Guanylate cyclase activators may benefit patients who continue to have symptoms from PAH on standard medical therapy regardless of the etiology of PAH.

DISCLOSURE: The following authors have nothing to disclose: Abdulah Alrifai, Brian Garnet, Varun Shah, Louis Lit

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