A meta-analysis of randomized controlled trials in pulmonary arterial hypertension.
A meta-analysis of randomized controlled trials in pulmonary arterial hypertension.
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DOI：
10.1093/eurheartj/ehp022
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发表时间：
2009-02
影响因子：
39.3
通讯作者：
Branzi A
中科院分区：
文献类型：
--
作者：
Galiè N;Manes A;Negro L;Palazzini M;Bacchi-Reggiani ML;Branzi A
肺动脉高压无法治愈，但目前批准的治疗方案包括前列腺素类、内皮素受体拮抗剂和5型磷酸二酯酶抑制剂。由于样本量小和持续时间短，这些化合物对生存的影响尚未在个体试验中进行适当评估。我们对所有在这种情况下发表的药物的随机对照试验进行了荟萃分析。在Medline数据库中检索1990年1月至2008年10月的试验。主要分析仅包括安慰剂对照组的研究，敏感性分析还包括比较两个活性治疗组的研究。主要结局指标为全因死亡率。21项试验被纳入主要分析（3140例患者），另外2项研究（59例患者）被纳入敏感性分析。审判的平均持续时间为14.3周。对照组全因死亡率为3.8%。活性治疗与死亡率降低43%相关（RR 0.57; 95% CI 0.35-0.92; P = 0.023）;敏感性分析证实死亡率降低38%（RR 0.62; 95% CI 0.39-1.00; P = 0.048）。该荟萃分析的结果表明，接受获批用于肺动脉高压的靶向治疗的患者的生存率有所改善。
There is no cure for pulmonary arterial hypertension, but current approved treatment options include prostanoids, endothelin-receptor antagonists, and phosphodiesterase type-5 inhibitors. The effect on survival of these compounds has not been appropriately assessed in individual trials because of small sample size and short duration. We performed a meta-analysis of all randomized controlled trials with drugs published in this condition. Trials were searched in the Medline database from January 1990 to October 2008. The primary analysis included only studies with a placebo comparator arm, the sensitivity analysis also included studies comparing two active treatment arms. The main outcome measure was all-cause mortality. Twenty-one trials were included in the primary analysis (3140 patients) and two additional studies (59 patients) were included in the sensitivity analysis. Average duration of the trials was 14.3 weeks. All-cause mortality rate in the control group was 3.8%. Active treatments were associated with a reduction in mortality of 43% (RR 0.57; 95% CI 0.35–0.92; P = 0.023); the sensitivity analysis confirmed a reduction in mortality of 38% (RR 0.62; 95% CI 0.39–1.00; P = 0.048). The results of this meta-analysis suggest an improvement of survival in the patients treated with the targeted therapies approved for pulmonary arterial hypertension.