A meta‑analysis of the safety and efficacy of bosentan therapy combined with prostacyclin analogues or phosphodiesterase type‑5 inhibitors for pulmonary arterial hypertension

Dang,Zhan‑Cui; Tang,Bo; Li,Bin; Liu,Shou; Ge,Ri‑Li; Li,Zhan‑Qiang; Lu,Dian‑Xiang

doi:10.3892/etm.2019.8142

A meta‑analysis of the safety and efficacy of bosentan therapy combined with prostacyclin analogues or phosphodiesterase type‑5 inhibitors for pulmonary arterial hypertension

Authors:
- Zhan‑Cui Dang
- Bo Tang
- Bin Li
- Shou Liu
- Ri‑Li Ge
- Zhan‑Qiang Li
- Dian‑Xiang Lu
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Affiliations: Research Center for High Altitude Medicine, Qinghai University, Xining, Qinghai 810000, P.R. China, Department of Orthopaedics, The First People's Hospital of Xining City in Qinghai Province, Xining, Qinghai 810000, P.R. China, Public Health Department, Medical College, Qinghai University, Xining, Qinghai 810000, P.R. China
Published online on: October 29, 2019 https://doi.org/10.3892/etm.2019.8142
Pages: 4740-4746
Copyright: © Dang et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

Bosentan is an effective drug for the treatment of pulmonary arterial hypertension (PAH). The aim of the present meta‑analysis was to examine the evidence concerning the efficacy and safety of bosentan therapy combined with prostacyclin analogues or phosphodiesterase type 5 (PDE‑5) inhibitors for treating PAH. Eligible published studies were collected from Embase, PubMed, The Cochrane Library and the www.clinicaltrials.gov website. Heterogeneity was assessed using the Cochran Q‑statistic test. Results were presented as risk ratios or mean differences with 95% confidence intervals (CI). A total of five studies, comprising 310 patients were included for analysis. No significant improvements in six‑minute walk distance (6MWD; mean difference, 16.43 m), clinical worsening (risk ratio, 0.54) and the World Health Organization functional classification (class I: risk ratio, 1.17; class II: risk ratio, 1.18) were observed in patients treated with bosentan in combination with prostacyclin analogues or PDE‑5 inhibitors. However, a significant reduction in the mean pulmonary artery pressure (mPAP; 95% CI: ‑17.06, ‑6.83; P<0.0001) following bosentan combination therapy was observed. Comparisons of adverse event rates in the bosentan combination therapy (55.6%) and monotherapy (51.8%) suggested that there is no reduction in adverse events (risk ratio, 1.10). The results indicated that bosentan combined with prostacyclin analogues or PDE‑5 inhibitors may not improve 6MWD, cardiac function, clinical worsening and adverse events. However, bosentan combined with prostacyclin analogues or PDE‑5 inhibitor therapy was able to significantly reduce mPAP compared with the effect of bosentan monotherapy.

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