J Korean Med Sci.  2020 Mar;35(8):e48. 10.3346/jkms.2020.35.e48.

The Clinical Efficacy of Pulmonary Hypertension-Specific Agents in Idiopathic Pulmonary Fibrosis: Systematic Review and Meta-Analysis of Randomized Controlled Clinical Trials

Affiliations
  • 1Department of Internal Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea. lovlet@paran.com
  • 2Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.

Abstract

BACKGROUND
Pulmonary hypertension (PH) is common in patients with idiopathic pulmonary fibrosis (IPF) and is associated with poor outcomes. This study was performed to determine the clinical efficacy of PH-specific therapeutic agents for IPF patients.
METHODS
We performed a systematic review and meta-analysis using MEDLINE, EMBASE, and the Cochrane Central Register. We searched randomized controlled trials (RCTs) without language restriction until November 2018. The primary outcome was all-cause mortality to end of study.
RESULTS
We analyzed 10 RCTs involving 2,124 patients, 1,274 of whom received PH-specific agents. In pooled estimates, the use of PH-specific agents was not significantly associated with reduced all-cause mortality to end of study compared with controls (hazard ratio, 0.99; 95% confidence interval [CI], 0.92, 1.06; P = 0.71; I² = 30%). When we performed subgroup analyses according to the type of PH-specific agent, sample size, age, forced vital capacity, diffusion lung capacity, and the extent of honeycombing, PH-specific agents also showed no significant association with a reduction in all-cause mortality. A small but significant improvement in quality of life, measured using the St. George Respiratory Questionnaire total score, was found in the PH-specific agent group (mean difference, −3.16 points; 95% CI, −5.34, −0.97; P = 0.005; I² = 0%). We found no significant changes from baseline in lung function, dyspnea, or exercise capacity. Serious adverse events were similar between the two groups.
CONCLUSION
Although PH-specific agents provided small health-related quality-of-life benefits, our meta-analysis provides insufficient evidence to support their use in IPF patients.

Keyword

Idiopathic Pulmonary Fibrosis; Hypertension, Pulmonary; Vasodilator Agents; Treatment Outcome

MeSH Terms

Diffusion
Dyspnea
Humans
Hypertension, Pulmonary
Idiopathic Pulmonary Fibrosis*
Lung
Lung Volume Measurements
Mortality
Quality of Life
Sample Size
Treatment Outcome*
Vasodilator Agents
Vital Capacity
Vasodilator Agents
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