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Original Research: Pulmonary Vascular Disease |

Efficacy and Safety of Pulmonary Arterial Hypertension-specific Therapy in Pulmonary Arterial Hypertension: A Meta-analysis of Randomized Controlled Trials

Huan-long Liu, MD, PhD; Xue-yan Chen, MD, PhD; Jie-ru Li, MSc; Su-wen Su, MD, PhD; Tao Ding, MSc; Chen-xia Shi, MD, PhD; Yun-fa Jiang, MD, PhD; Zhong-ning Zhu, MD, PhD
Author and Funding Information

Drs Liu and Chen contributed equally to this work.

FUNDING/SUPPORT: This study was supported by the Natural Science Foundation of China (NSFC, 81273600), the Natural Science Foundation of Hebei Province (H2013206147; C2011206145), and the Research Project of Education Department, Hebei Province (ZD2014001).

aDepartment of Pharmacy, Second Hospital of Hebei Medical University, Shijiazhuang, China

bDepartment of Cardiology, Second Hospital of Hebei Medical University, Shijiazhuang, China

cDepartment of Pharmacology, Hebei Medical University, Shijiazhuang, China

dHebei Key Laboratory of Chinese Medicine Research on Cardio-Cerebrovascular Disease, Hebei University of Chinese Medicine, Shijiazhuang, China

eDepartment of Physiology, Hebei University of Chinese Medicine, Shijiazhuang, China

CORRESPONDENCE TO: Yun-fa Jiang, MD, PhD, Department of Cardiology, Second Hospital of Hebei Medical University, 215 Heping West Rd, Shijiazhuang, 050000, China


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;150(2):353-366. doi:10.1016/j.chest.2016.03.031
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Background  Previous meta-analyses of pulmonary arterial hypertension (PAH)-specific therapy for PAH pooled PAH-specific combination therapy and monotherapy. This flaw may threaten the authenticity of their findings.

Methods  PubMed, Embase, and the Cochrane Library were searched for randomized controlled trials that evaluated any PAH-specific medications in the treatment of PAH. We calculated ORs with 95% CIs for dichotomous data and standardized mean differences for continuous data.

Results  In total, 35 randomized controlled trials involving 6,702 patients were included. In monotherapy vs placebo/conventional therapy, significance was obtained in mortality reduction (OR, 0.50 [95% CI, 0.33 to 0.76]; P = .001), 6-min walk test (mean difference, 31.10 m [95% CI, 25.40 to 36.80]; P < .00001), New York Heart Association/World Health Organization functional class (OR, 2.48 [95% CI, 1.51 to 4.07]; P = .0003), and hemodynamic status based on mean pulmonary artery pressure, pulmonary vascular resistance, cardiac index, and incidence of withdrawal due to adverse effects. In combination therapy vs monotherapy, significance was reached for the 6-min walk test (mean difference, 19.96 m [95% CI, 15.35 to 24.57]; P < .00001), functional class (OR, 1.65 [95% CI, 1.20 to 2.28]; P = .002), hemodynamic status, and incidence of withdrawal due to adverse effects (OR, 2.01 [95% CI, 1.54 to 2.61]; P < .00001) but not for mortality reduction (OR, 0.98 [95% CI, 0.57 to 1.68]; P = .94).

Conclusions  Our meta-analysis revealed that PAH-specific monotherapy could improve mortality, exercise capacity, functional class, and hemodynamic status compared with placebo or conventional therapy. However, combination therapy could further improve exercise capacity, functional class, and hemodynamic status compared with monotherapy, but it had no proven effect on mortality. Combination therapy had a much higher incidence of withdrawal due to adverse effects than monotherapy.

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