Meta-analysis Of The Efficacy And Safety Of Target Therapy In Idiopathic Pulmonary Arterial Hypertension

Objective: A Meta-analysis was conducted to study the efficacy and safety of different target therapies for patients with idiopathic pulmonary arterial hypertension(IPAH).Methods : Two researchers searched English databases(PubMed,Cochrane Library,Embase)and Chinese databases(CNKI,VIP,WanFang Data and CBM)independently.Extracted data and conducted the quality assessment,the meta-analysis was performed by Stata 15.1.Results: In total,2 randomized controlled trials(RCT)and 16 prospective cohort studies(Pro),465 patients with target therapy and 61 patients in the control group included in the 2 RCTs were included.It is demonstrated that mortality was about 5.1% for the patients with target therapy,the bosentan accounts for 7.3%,the prostacyclin analogues(ProsA)account for 3.1%,six patients in the phosphodiesterase 5 inhibitor(PDE-5i)group followed up for 6 months were alived.And the mortality of control group was 18.0%.The rate of withdrawal due to adverse effects in ProsA group was 1.8%,and the rate of Bosentan was 2.7%,there was not dropout in PDE-5i group.Targeted therapy could improve 6-minutes walk distance(6MWD)(SMD=0.70,95%CI[0.53,0.87],P<0.05),and the group of ProsA SMD=0.54(95%CI[0.24,0.84],P<0.05),and the group of Bosentan SMD=0.93(95%CI[0.22,1.64],P<0.05).Bosontan reduced pulmonary vascular resistance(PVR)(SMD=-0.77,95% CI[-1.23,-0.32],P<0.05)and mean pulmonary artery pressure(mPAP)(SMD=-0.72,95% CI[-1.10,-0.35],P<0.05).The effect of ProsA with pulmonary circulatory hemodynamics needs more data.The target therapy of PDE-5i was not meta analyzed due to insufficient data.Conclusion: The targeted drugs are safety for IPAH,it can reduce all-cause mortality of IPAH in short-term.Bosentan can improve the motor tolerance and pulmonary circulation hemodynamics,the effectiveness of PDE-5i and ProA needs further study.