medwireNews: Oral treatments for pulmonary arterial hypertension (PAH) reduce patients’ risk of clinical worsening but have little effect on survival, say the authors of a meta-analysis.
They suggest that oral treatments may benefit patients in World Health Organisation (WHO) functional classes I and II, and those in class III who have relatively moderate symptoms, whereas for patients with more severe symptoms “a change in therapy or combined therapy with inhaled, subcutaneous, or intravenous prostanoids may be required.”
Zhi-Cheng Jing (Tongji University School of Medicine, Shanghai, China) and team’s meta-analysis included 21 studies with 5105 patients.
The combined clinical worsening rate was 11.3% among patients who received oral PAH treatments, compared with 17.9% among those who received placebo, equating to a significant 45% reduction in the risk of clinical worsening among treated patients. Clinical worsening events encompassed all-cause mortality, lung transplantation, hospitalisation for PAH and escalation of treatment.
Drugs that were subsequently approved for clinical use in PAH patients were also associated with about a 50% reduced risk of treatment escalation and of hospitalisation for PAH.
However, mortality rates did not significantly improve with treatment, at 2.5% among treated patients and 3.3% among those taking placebo, and this was true for both approved and unapproved drugs.
The team found an association between clinical outcomes and patients’ 6-minute walk distance (6MWD), such that larger improvements in 6MWD from baseline were associated with a smaller risk of clinical worsening. And this relationship persisted after accounting for patients’ age, gender and WHO functional class, as well as the class of drug they were receiving. Larger 6MWD improvements also tended to be associated with a reduced mortality risk, although this was not statistically significant.
This finding suggests that “monitoring the change in 6MWD may be beneficial for predicting [combined clinical worsening] events”, write the researchers in the American Heart Journal.
However, they note that this finding contradicts a previous study and therefore advise more research into the relationship between 6MWD and clinical outcomes.
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