Drug therapy for chronic thromboembolic pulmonary hypertension: a review of the comparative clinical effectiveness

CADTH
Record ID 32015000157
English
Authors' recommendations: In the studies reviewed in this report, riociguat was associated with significant improvement in the 6-minute walk distance (6-MWD), pulmonary vascular resistance (PVR), mean pulmonary-artery pressure (mPAP) and cardiac output. World Health Organization (WHO) functional classes in patients receiving riociguat showed significantly favorable changes at 16 weeks compared to placebo. A systematic review and meta-analysis involving a total of eleven studies of various designs showed that following a three-to-six months therapy with bosentan, patients with inoperable CTEPH as well as patients with persistent or recurrent pulmonary hypertension after pulmonary endarterectomy gained significant improvement in the 6-MWD, cardiac index, PAP, and PVR. Another study found that pretreatment with a combination of bosentan and best standard care (defined as use of anticoagulants with or without diuretics and/or oxygen, if clinically indicated) in CTEPH patients awaiting PEA demonstrated significantly greater improvements in 6-MWD and hemodynamic outcomes compared with best standard care alone. In addition, the pretreatment appeared to confer significant right ventricular (RV) remodeling advantages not observed in patients who received best standard care alone. However, the duration of stay in the intensive care unit or the duration of mechanical ventilation use showed no significant difference between the two groups. Sildenafil, administered orally at 40 mg three times daily for 12 weeks, demonstrated significant improvement in PVR compared with placebo, but improvement in 6-MWD did not reach significance.
Details
Project Status: Completed
Year Published: 2014
URL for published report: http://www.cadth.ca/media/pdf/htis/dec-2014/RC0580%20Drug%20for%20CTEPH%20Final.pdf
English language abstract: An English language summary is available
Publication Type: Not Assigned
Country: Canada
MeSH Terms
  • Hypertension, Pulmonary
  • Pyrazoles
  • Pyrimidines
  • Antihypertensive Agents
  • Sildenafil Citrate
Contact
Organisation Name: Canadian Agency for Drugs and Technologies in Health
Contact Address: 600-865 Carling Avenue, Ottawa, ON K1S 5S8 Canada. Tel: +1 613 226 2553; Fax: +1 613 226 5392;
Contact Name: requests@cadth.ca
Contact Email: requests@cadth.ca
Copyright: Canadian Agency for Drugs and Technologies in Health (CADTH)
This is a bibliographic record of a published health technology assessment from a member of INAHTA or other HTA producer. No evaluation of the quality of this assessment has been made for the HTA database.