Vardenafil in Pulmonary Arterial Hypertension

Jing, Zhi‐Cheng; Yu, Zaixin; Shen, Jieyan; Bing-xiang, WU; Xu, Kai‐Feng; Xianyang, Zhu; Pan, Lei; Zhang, Zhuoli; Liu, Xueqin; Zhang, Yushun; Jiang, Xin; Galiè, Nazzareno

doi:10.1164/rccm.201101-0093oc

Cited by 155 publications

(61 citation statements)

References 29 publications

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“…1). 5–9,13–31 As ARIES-1 and ARIES-2 were reported in one article, 25 RCTs were included. 24 Among them, 11 assessed the effects of ERAs, seven assessed the effects of PDE-5Is, five assessed the effects of prostacyclin analogues, two assessed the effects of prostacyclin receptor agonists, and one assessed the effects of sGCs.…”

Section: Resultsmentioning

confidence: 99%

“…5,8,9,15–24,26,29 In the other five trials that did not report this endpoint as defined, we extracted the data according to the definition. 16,25,27,30,31 If the study did not report all the relevant endpoints of clinical worsening, we combined the reported endpoints together as clinical worsening.…”

Section: Resultsmentioning

confidence: 99%

“…Of the 25 trials, ten assessed the effects of PAH-specific monotherapy, 18,20,24–26,28–31 nine assessed the effects of combination therapy, 5–9,17,19,22,27 and the other six included both treatment-naïve and background vasodilator-treated patients. 13–16,21,23 A meta-analysis of ten studies with only treatment-naïve patients revealed that monotherapy was associated with a significant reduction in clinical worsening (RR = 0.46; 95% CI = 0.34–0.62; P < 0.001).…”

Section: Resultsmentioning

confidence: 99%

“…In the present study, we performed a new meta-analysis on PAH therapy with all oral targeted drugs, 5–9,13–31 including data from six recently published randomized controlled trials (RCTs), 5–8,13,16 with the aim of determining whether the benefits of oral targeted therapies on exercise capacity and hemodynamics are translated into improvement of clinical outcomes, particularly overall mortality and morbidity.…”

Section: Introductionmentioning

confidence: 99%

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Efficacy and safety of oral targeted therapies in pulmonary arterial hypertension: a meta‐analysis of randomized clinical trials

Zheng

Chen

et al. 2018

Pulm. circ.

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Oral targeted therapies play an important role in the treatment of pulmonary arterial hypertension (PAH). Several new oral agents have emerged for PAH in recent years. However, whether they provide a survival advantage is still not clear. This meta-analysis aimed to assess the efficacy and safety of oral targeted therapies, especially on predefined clinical worsening events. Trials were searched in the Cochrane Library, EMBASE, and PUBMED databases through June 2018. We calculated risk ratios for dichotomous data and weighted mean differences with 95% confidence intervals (CI) for continuous data. Twenty-five trials with a total of 6847 participants were included in the meta-analysis. Oral targeted therapies were associated with significant risk reduction in clinical worsening compared with placebo (relative risk [RR] 0.64; 95% CI = 0.58–0.70; P < 0.001). This reduction in risk was driven by reduction in non-fatal endpoints, including PAH-related admissions to hospital (RR = 0.66; 95% CI = 0.56–0.76; P < 0.001), treatment escalation (RR = 0.43; 95% CI = 0.28–0.66; P < 0.001), and symptomatic progression (RR = 0.55; 95% CI = 0.48–0.64; P < 0.001), but not by reduction of mortality (RR = 0.87; 95% CI = 0.68–1.12; P = 0.215). Oral targeted therapies were also associated with improvement in 6-min walk distance (26.62 m; 95% CI = 20.54–32.71; P < 0.001) and World Health Organization functional class (RR = 1.36; 95% CI = 1.20–1.54; P < 0.001). The results of this meta-analysis showed the benefits of oral treatments on clinical worsening events in PAH. However, these oral agents did not show any survival benefit in the short-term follow-up.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Efficacy and safety of oral targeted therapies in pulmonary arterial hypertension: a meta‐analysis of randomized clinical trials

Zheng

Chen

et al. 2018

Pulm. circ.

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“…It differs from already marketed PDE-5 inhibitors by having a short effective time and slight longer half life than that of sildenafil. The EVALUATION study by Jing et al, which sought out to demonstrate safety and efficacy of Vardenafil showed that it is well tolerated in twice daily dosing and showed a increase in 6MWD, and cardiac index, along with an decrease in mean pulmonary arterial pressure and pulmonary vascular resistance [51].…”

Section: Future Medicationsmentioning

confidence: 99%

Pulmonary Arterial Hypertension: A Current Review of Pharmacological Management

Sahni

Ojrzanowski²,

Majewski

et al. 2015

Advances in Respiratory Medicine

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Pulmonary hypertension (PHTN) is a rare and devastating disease characterized by progressive increases in pulmonary arterial pressure and pulmonary vascular resistance, which eventually leads to right ventricular failure and death. At present there is no cure for pulmonary arterial hypertension (PAH); however over the past decade targeted pharmaceutical options have become available for the treatment of PAH. Prior to evaluation for therapeutic options a definitive diagnosis of pulmonary arterial hypertension must be made via comprehensive physical exam and definitive diagnostic testing. Screening test of choice remains echocardiography and gold standard for definitive diagnosis is right heart catheterization. Once the establishment of a diagnosis of PAH is made therapeutic options may be a possibility based on a diagnostic algorithm and disease severity of the PAH patient. There are different classes of medications available with different mechanisms of actions which have a vasodilatory effect and improve exercise tolerance, quality of life as well as survival.

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