Primerjalna učinkovitost zdravil za zdravljenje pljučne arterijske hipertenzije

Petek, Andrej (author), Locatelli, Igor (mentor)

Pljučna arterijska hipertenzija je bolezen, pri kateri je srednji tlak v pljučni arteriji večji ali enak 25 mmHg. Bolezen spada v prvo skupino razdelitve pljučne hipertenzije po svetovni zdravstveni organizaciji. Po svetovni zdravstveni organizaciji je pljučna arterijska hipertenzija razdeljena na idiopatsko, dedno, z zdravili in toksini povzročeno, ter povezano z drugimi sistemskimi boleznimi. V smernicah se po priporočilih pljučna arterijska hipertenzija specifično zdravi s skupinami zdravil, kot so antagonisti endotelinskega receptorja, inhibitorji fosfodiesteraze tipa 5, prostaciklinski analogi, stimulatorji topne gvanilat ciklaze in agonisti prostaciklinskega receptorja. Naš namen je bil sistematično pregledati najnovejše dokaze o učinkovitosti zdravil in skupin zdravil za zdravljenje pljučne arterijske hipertenzije in predstaviti rezultate za učinkovitost zdravil in vpliv zdravil na smrtnost za zdravila ambrisentan, bosentan, macitentan, sildenafil, tadalafil, beraprost, epoprostenol, iloprost, treprostinil, riociguat in seleksipag. V raziskavo smo vključili 11 učinkovin in s pomočjo kriterijev poiskali ustrezne študije, te smo sistematično pregledali in opravili metaanalize s programom Review Manager 5.3. Rezultate smo podali kot učinkovitost učinkovin z razliko povprečij izida poti prehojene v šestih minutah in vplivom na smrtnost z razmerjem obetov za vse študije, za študije brez pridruženega zdravljenja, za študije s konvencionalnim pridruženim zdravljenjem in za študije s specifičnim pridruženim zdravljenjem. Ugotovili smo, da je epoprostenol najbolj učinkovit in ima tudi največji vpliv na smrtnost za vse študije in za študije s konvencionalnim pridruženim zdravljenjem.Za študije brez pridruženega zdravljenja je učinkovitost najboljša pri ambrisentanu, največji vpliv na smrtnost pa ima bosentan. Če pa pogledamo študije s specifičnim pridruženim zdravljenjem, je najbolj učinkovit iloprost, največji vpliv na smrtnost pa ima riociguat. Rezultati naše metaanalize so primerljivi z rezultati že objavljenih metaanaliz.

• Language: Slovenian
• Keywords: Pljučna arterijska hipertenzija, metaanaliza, pridruženo zdravljenje
• Work type: Master's thesis/paper
• Organization: FFA - Faculty of Pharmacy
• Year: 2019
• PID: 20.500.12556/RUL-112639
• Publication date in RUL: 29.10.2019

Secondary language

• Language: English
• Title: Comparative effectiveness of medicines for pulmonary arterial hypertension

Abstract

Pulmonary arterial hypertension is a disease defined by the mean pulmonary arterial pressure same or greater than 25 mmHg. Pulmonary arterial hypertension belongs to the first group of pulmonary hypertension by distribution of world health organisation. According to world health organisation, Pulmonary arterial hypertension is divided into idiophatic, heritable pulmonary arterial hypertension, pulmonary arterial hypertension associated with drugs and toxins and pulmonary arterial hypertension with other systemic diseases. The guidelines recommend specific treatment of pulmonary arterial hypertension with medicine groups such as endothelin receptor antagonists, phosphodiesterase type 5 inhibitors, prostacyclin analogues, soluble guanylate cyclase stimulators and prostacyclin receptor agonists. Our purpose was to systematically review the latest evidence for the efficacy of drugs and drug groups for the treatment of pulmonary arterial hypertension and to present results for drug efficacy and drug effects on mortality for ambrisentan, bosentan, macitentan, sildenafil, tadalafil, beraprost, epoprostenol, iloprost, treprostinil, riociguate and selexipag. We included 11 active substances in the search set. Studies were included if they meet exclusion and inclusion criteria. The included studies were systematically reviewed and performed meta-analysis with Review Manager 5.3. The results were reported as the efficacy of the active substances, with the mean diffrences of six minutes walk distance and the impact on mortality with the odds ratio for all studies, for studies with no associated treatment, for studies with conventional background therapy and for studies with specific background therapy. Epoprostenol has been found to be the most effective and has the greatest impact on mortality for all studies and for studies with conventional background therapy. with specific background therapy, iloprost is the most effective and riociguate has the greatest impact on mortality. The results of our meta-analysis are comparable to the results of previously published meta-analyzes.

• Keywords: Pulmonary arterial hypertension, meta-analysis, background therapy