Targeted Drug Combination Therapy For Pulmonary Arterial Hypertension:A Meta-analysis

Objective: To evaluate the efficacy and safety of targeted drug combination therapy for Pulmonary Arterial Hypertension.Methods:PubMed,Cochrane Central Register of Controlled Trials,Chinese Biomedical Literature(CBM),Chinese National Knowledge Infrastructure(CNKI)and Wanfang databases were searched from establishment to April 2017.RCTs of targeted drug combination therapies for patients with PAH were eligible.The primary outcome was mortality,tolerability exercise capacity and clinical worsening.The data were retrieved and the relevant data were extracted.The count data were expressed as the relative ratio(RR)and the 95% confidence interval(CI),The measured data were expressed as(mean difference,MD)and its 95% CI.Statistical analysis was performed with RevMan 5.3 software and evaluate the results.When the heterogeneity is small,the fixed effect model is adopted,otherwise the random effect model is adopted.Results: 19 randomized controlled trials were included,with a total sample size of 4202 patients.The results showed that compared with the monotherapy group,the combined treatment group significantly reduced the clinical deterioration rate [RR = 0.62,95% CI(0.54,0.70),P <0.00001],and increased the patient's 6-minute walking distance [MD = 26.81 m,95%(RR = 1.19,95% CI(1.01,1.40),P <0.04],and reduced the mean pulmonary arterial pressure [MD = 5.9 mmHg,95% CI,P <0.0001](-8.48,-3.32),P <0.00001],and pulmonary circulation resistance [MD = 214.74 dyn.s-1.cm-5,95% CI(-269.50,-159.97),P <0.00001].There was no statistically significant difference in mortality between the two groups(P = 0.1).There was a significant difference in the proportion of the two groups who were discontinued for various reasons(P = 0.0009),the combined therapy group was higher than the monotherapy group.Conclusion:The available evidence suggested that the combination therapy of drug therapy can significantly improve the patient's exercise tolerance,pulmonary hemodynamic parameters and reduce the risk of clinical deterioration.However,combination therapy than monotherapy can not reduce the mortality of patients,and poor tolerance.