Pulmonary artery denervation versus conventional therapies for PAH: a systematic review and updated network meta-analysis.

Autor: Wu X; Department of Biostatistics, School of Public Health, Center of Global Health, Nanjing Medical University, Nanjing, China., Wang X; Department of Biostatistics, School of Public Health, Center of Global Health, Nanjing Medical University, Nanjing, China., Zhang L; Department of Biostatistics, School of Public Health, Center of Global Health, Nanjing Medical University, Nanjing, China., Pan Z; Department of Biostatistics, School of Public Health, Center of Global Health, Nanjing Medical University, Nanjing, China., Chen F; Department of Biostatistics, School of Public Health, Center of Global Health, Nanjing Medical University, Nanjing, China., Chen SL; Department of Cardiology, Nanjing First Hospital, The Affiliated Nanjing Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China., Kan J; Department of Cardiology, Nanjing First Hospital, The Affiliated Nanjing Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China., Wei Y; Department of Biostatistics, School of Public Health, Center of Global Health, Nanjing Medical University, Nanjing, China.; Center for Public Health and Epidemic Preparedness & Response, Peking University, Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China.
Jazyk: angličtina
Zdroj: ESC heart failure [ESC Heart Fail] 2024 Oct; Vol. 11 (5), pp. 2889-2900. Date of Electronic Publication: 2024 May 23.
DOI: 10.1002/ehf2.14842
Abstrakt: Aims: A recent guideline presented by the ESC Congress in 2022 had indicated a novel therapy targeted at pulmonary artery hypertension, known as pulmonary artery denervation (PADN), which get inspired from a laboratorial trial that could lowering the pulmonary artery pressure through the intervention on the animals. Our aim is to conduct a network meta-analysis to compare the efficacy and safety of PADN from six aspects with the current conventional therapies.
Methods and Results: According to the PRISMA guidance, databases including Ovid, ClinicalTrials.gov, Medline, Embase, and PubMed were searched from inception to 22 August 2023, along with a full assessment of the previous five meta-analyses. Data were extracted and curated for Bayesian network meta-analysis. The primary outcome was the change in the 6-min walking distance (6MWD) from baseline with a secondary outcome called change in mean pulmonary artery pressure (mPAP) from baseline. The four safety outcomes included risk of clinical worsening, hospitalization, mortality and severe adverse events (SAEs). The comparison is structured on a contrast model based on 65 randomized controlled trials (RCTs) on PADN and the other conventional mainstream drugs. PADN had a better effect in improving 6MWD than Placebo (-77.76 m, 95% CI: -102.04 to -54.34 m), Macitentan (-65.32 m, 95% CI: -95.34 to -36.1 m), Bosentan (-64.5 m, 95% CI: -94.7 to -35.07 m), Iloprost (-62.66 m, 95% CI: -99.48 to -27.13 m), Oxygen (-62.42 m, 95% CI: -100.01 to -25.78 m), Treprostinil (-62.01 m, 95% CI: -89.04 to -35.61 m), Riociguat (-60.59 m, 95% CI: -86.11 to -35.98 m), Selexipag (-47.2 m, 95% CI: -85.61 to -10.19 m), Sildenafil (-44.92 m, 95% CI: -74.43 to -16.15 m), or Sitaxsentan (-39.53 m, 95% CI: -78.99 to -0.76 m). PADN had a better antihypertensive effect than placebo and showed statistical significant lower risks to induce clinical worsening and re-hospitalization than treprostinil, riociguat, and placebo groups. No statistically significant difference in risk of mortality and severe adverse events was observed between PADN versus the other interventions.
Conclusions: Compared with 16 types of conventional therapies and Placebo, PADN has advantage over nine single therapies and Placebo in improving 6MWD and appears to be better than two types of dual-drug combined therapies while with no statistical significance. PADN shows a favourable antihypertensive effect on mPAP and has a lower risk to trigger clinical worsening or hospitalization, while its risk on mortality and severe adverse events is still inconclusive.
(© 2024 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.)
Databáze: MEDLINE
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