Comparative effectiveness of pulmonary arterial hypertension drugs in treatment-naive patients: a network meta-analysis

Petrovič, Maja; Locatelli, Igor

doi:10.2217/cer-2019-0037

Cited by 5 publications

(12 citation statements)

References 44 publications

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“…The publication year ranged between 2007 [ 43 ] and 2020 [ 39 , 41 , 48 , 67 ] with most studies published in recent years. MAs were conducted in 35 studies [ 17 , 19 , 20 , 22 , 23 , 26 – 29 , 31 , 35 – 41 , 43 – 47 , 49 – 51 , 53 , 56 , 58 – 60 , 63 – 66 , 69 ], NMAs in 15 studies [ 18 , 21 , 24 , 25 , 30 , 32 , 33 , 42 , 48 , 52 , 54 , 57 , 61 , 62 , 67 ], both NMA and MA in one study [ 55 ], and MA and disproportionality analysis in one study [ 34 ]. Of 52 studies, 47 evaluated the impact of PAH interventions in patients with PAH and PAH subgroups (based on aetiology, e.g.…”

Section: Resultsmentioning

confidence: 99%

“…With a number of exceptions [ 17 , 20 , 24 , 25 , 34 , 35 , 39 – 41 , 45 , 47 , 54 , 58 , 59 , 61 , 62 , 64 ], most studies investigated treatments targeting all three pathways. All the approved treatments (ERA, PDE-5Is, PRAs, prostacyclin and sGCS) were investigated in nine recent studies [ 27 , 30 , 38 , 42 , 46 , 48 , 57 , 63 , 67 ]. Some studies included treatments approved in limited markets such as beraprost [ 38 , 40 , 48 , 50 , 51 , 57 , 61 , 65 , 67 ].…”

Section: Resultsmentioning

confidence: 99%

“…MEDLINE, Embase, CENTRAL [ 18 , 29 , 32 , 34 , 35 , 43 , 44 , 50 , 51 , 66 ]. Several studies did not provide details of the search strategy [ 18 – 21 , 24 – 26 , 29 , 31 , 32 , 35 , 36 , 39 , 40 , 43 – 45 , 48 , 50 – 53 , 57 – 59 , 61 , 65 – 67 ] and one study did not provide any details on the search strategy and searched databases [ 56 ].…”

Section: Resultsmentioning

confidence: 99%

“…NMA) are more appropriate in this case. Of the included NMA studies with closed loops, most assessed the consistency between the direct and indirect evidence [ 13 , 14 , 48 , 57 , 62 ].…”

Section: Resultsmentioning

confidence: 99%

“…All the approved treatments (ERA, PDE-5Is, PRAs, prostacyclin and sGCS) were investigated in nine recent studies [27,30,38,42,47,49,50,59,65]. Some studies included treatments approved in limited markets such as beraprost [38,40,49,50,52,53,59,63,67]. In nine studies, drugs targeting one pathway only were investigated: prostacyclins in five studies [40,48,61,63,66] and ERAs in four studies [25,46,60,64].…”

Section: Study Characteristicsmentioning

confidence: 99%

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Evidence synthesis in pulmonary arterial hypertension: a systematic review and critical appraisal

et al. 2020

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Background: The clinical landscape of pulmonary arterial hypertension (PAH) has evolved in terms of disease definition and classification, trial designs, available therapies and treatment strategies as well as clinical guidelines. This study critically appraises published evidence synthesis studies, i.e. meta-analyses (MA) and network-metaanalyses (NMA), to better understand their quality, validity and discuss the impact of the findings from these studies on current decision-making in PAH. Methods: A systematic literature review to identify MA/NMA studies considering approved and available therapies for treatment of PAH was conducted. Embase, Medline and the Cochrane's Database of Systematic Reviews were searched from database inception to April 22, 2020, supplemented by searches in health technology assessment websites. The International Society for Pharmacoeconomics and Outcomes Research (ISPOR) checklist covering six domains (relevance, credibility, analysis, reporting quality and transparency, interpretation and conflict of interest) was selected for appraisal of the included MA/NMA studies. Results: Fifty-two full publications (36 MAs, 15 NMAs, and 1 MA/NMA) in PAH met the inclusion criteria. The majority of studies were of low quality, with none of the studies being scored as 'strong' across all checklist domains. Key limitations included the lack of a clearly defined, relevant decision problem, shortcomings in assessing and addressing between-study heterogeneity, and an incomplete or misleading interpretation of results. Conclusions: This is the first critical appraisal of published MA/NMA studies in PAH, suggesting low quality and validity of published evidence synthesis studies in this therapeutic area. Besides the need for direct treatment comparisons assessed in long-term randomized controlled trials, future efforts in evidence synthesis in PAH should improve analysis quality and scrutiny in order to meaningfully address challenges arising from an evolving therapeutic landscape.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…NMA) are more appropriate in this case. Of the included NMA studies with closed loops, most assessed the consistency between the direct and indirect evidence [ 13 , 14 , 48 , 57 , 62 ].…”

Section: Resultsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

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Evidence synthesis in pulmonary arterial hypertension: a systematic review and critical appraisal

et al. 2020

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Efficacy and safety of novel-targeted drugs in the treatment of pulmonary arterial hypertension: a Bayesian network meta-analysis

et al. 2021

Drug Delivery

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Background: Pulmonary arterial hypertension (PAH) is a severe and fatal clinical syndrome characterized by high blood pressure and vascular remodeling in the pulmonary arterioles, which is also a rapidly progressing disease of the lung vasculature with a poor prognosis. Although PAH medication made great advances in recent years, the efficacy and safety of the medication are unsatisfactory. Therefore, we aimed to update and expand previous studies to explore the efficacy and safety of PAH-targeted medications. Methods: Relevant articles were searched and selected from published or publicly available data in PubMed, Cochrane Library, CNKI, PsycInfo, and MEDLINE (from inception until October 1 st , 2020). To assess the efficacy and safety of PAH therapies, five efficacy outcomes [6-minute walking distance (6MWD), mean pulmonary arterial pressure (mPAP), WHO functional class (WHO FC) improvement, clinical worsening, death] and two safety outcomes [adverse events (AEs), serious adverse events (SAEs)] were selected. And 6MWD was regarded as the primary efficacy outcome. Results: 50 trials included with 10 996participants were selected. In terms of efficacy, all targeted drugs were more effective than placebo. For 6MWD, Bosentan + Sildenafil, Sildenafil, Bosentan + Iloprost were better than others. Bosentan + Iloprost and Bosentan + Sildenafil were better for mPAP. Bosentan + Iloprost and Ambrisentan + Tadalafil were more effective in improving WHO FC. Bosentan + Tadalafil and Bosentan + Iloprost had the Ambrisentan probability to reduce the incidence of clinical worsening. It is demonstrated that Ambrisentan had clear benefits in reducing all-cause mortality. In terms of safety, no therapies had been shown to reduce the incidence of SAEs significantly, and Ambrisentan + Tadalafil significantly increased the incidence of AEs. Conclusions: Phosphodiesterase 5 inhibitor (PDE5i) + Endothelin Receptor Antagonists (ERA) seems to be better therapy for PAH. Prostacyclin analogs (ProsA) + ERA appear promising, though additional data is warranted. Registration PROSPERO CRD42020218818.

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Strategies for optimizing intravenous prostacyclin-analog therapy in patients with pulmonary arterial hypertension

Ewert

Habedank

Halank³

et al. 2021

Expert Review of Respiratory Medicine

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Comparative effectiveness of pulmonary arterial hypertension drugs in treatment-naive patients: a network meta-analysis

Cited by 5 publications

References 44 publications

Evidence synthesis in pulmonary arterial hypertension: a systematic review and critical appraisal

Evidence synthesis in pulmonary arterial hypertension: a systematic review and critical appraisal

Efficacy and safety of novel-targeted drugs in the treatment of pulmonary arterial hypertension: a Bayesian network meta-analysis

Strategies for optimizing intravenous prostacyclin-analog therapy in patients with pulmonary arterial hypertension

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