Meta-analysis of randomized controlled trials on treatment of pulmonary arterial hypertension.
BACKGROUND
The aim of the present meta-analysis was to evaluate the efficacy and safety of treating pulmonary arterial hypertension (PAH) with inhaled iloprost, oral bosentan and sildenafil.


RESULTS
The randomized controlled trials on the 3 drugs and placebo were retrieved from the databases MEDLINE, EMBASE, BIOSIS Previews and CNKI up to August 2009. In total 11 studies and 1,391 patients were selected. Compared with placebo, iloprost, bosentan and sildenafil reduced clinical worsening significantly (odds ratio [OR] =0.33, 95% confidence interval [CI] =0.22-0.49, P<0.00001), improved New York Heart Association/World Health Organization functional class (OR =2.81, 95%CI =1.95-4.03, P<0.00001), increased the 6-min walk test by 33.19 m, reduced systolic pulmonary arterial pressure, mean pulmonary arterial pressure and pulmonary vascular resistance, increased the cardiac index by 0.40 L x min(-1) x m(-2) and increased the cardiac output by 0.53 L/min. The incidence of serious adverse events was similar in the medication groups and the placebo group (OR =1.09, 95%CI =0.69-1.71, P=0.72). In terms of the clinical worsening and functional class amelioration, insignificant differences were found among iloprost, bosentan and sildenafil, but iloprost had the highest incidence of serious adverse events among the 3 drugs.


CONCLUSIONS
Inhaled iloprost and oral bosentan and sildenafil are effective and safe in treating PAH.
Department of Pediatrics, Renmin Hospital of Wuhan University, Wuhan, China.
Bing
B
He
Fengwen
F
Zhang
Xueying
X
Li
Chaoshu
C
Tang
Guosheng
G
Lin
Junbao
J
Du
Hongfang
H
Jin
D000959:Antihypertensive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D000077300:Bosentan; D064420:Drug-Related Side Effects and Adverse Reactions; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications / Q000188:drug therapy*; D016285:Iloprost / Q000009:adverse effects / Q000627:therapeutic use; D010879:Piperazines / Q000009:adverse effects / Q000627:therapeutic use; D011687:Purines / Q000009:adverse effects / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data*; D000068677:Sildenafil Citrate; D013449:Sulfonamides / Q000009:adverse effects / Q000627:therapeutic use; D013450:Sulfones / Q000009:adverse effects / Q000627:therapeutic use; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000009:adverse effects / Q000627:therapeutic use
D000959:Antihypertensive Agents; D010879:Piperazines; D011687:Purines; D013449:Sulfonamides; D013450:Sulfones; D014665:Vasodilator Agents; D000068677:Sildenafil Citrate; D016285:Iloprost; D000077300:Bosentan