Balloon Pulmonary Angioplasty and Adempas Both Effective for Inoperable CTEPH, Analysis Shows

A new meta-analysis assessing balloon pulmonary angioplasty (BPA) and Adempas (riociguat) for treating inoperable chronic thromboembolic pulmonary hypertension (CTEPH) found both treatment strategies to be well-tolerated, and able to improve exercise tolerance and the function of the circulatory system.

The study with that finding, “Balloon pulmonary angioplasty vs riociguat in patients with inoperable chronic thromboembolic pulmonary hypertension: A systematic review and meta‐analysis,” was published in the journal Clinical Cardiology.

The “gold standard” for treating CTEPH is a surgical procedure called pulmonary thromboendarterectomy, but not all CTEPH patients are eligible for surgery. For these ineligible patients, treatment may include Adempas (a medicine developed by Bayer that helps widen blood vessels) or BPA.

BPA involves using a catheter to place a balloon in a central vein. By blowing up the balloon, the vessel walls can be mechanically widened, and anything that’s blocking the normal flow of blood can be pushed.

In essence, both Adempas and BPA aim to accomplish a similar goal, but through different means. Might one of these treatment strategies lead to better outcomes than the other?

To find out, a team led by researchers at Chongqing Medical University in China, performed a systematic review of scientific literature. In their meta-analysis, the team found 17 studies about BPA, and six studies on Adempas, including 631 and 823 people, respectively, who underwent each procedure.

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Researchers compared results from studies on both treatment strategies using statistical models.

Results showed that hemodynamic parameters (measurements of how well blood is flowing), including the average pressure in the pulmonary artery and the right atrium of the heart, were reduced by both treatment strategies.

In most of the measured parameters, BPA was, on average, more effective (i.e. lowered pressure more) than Adempas. However, there also was higher heterogeneity in these parameters among BPA studies; that is, there was a wider range of results among all of the included studies.

The only exception among hemodynamic parameters was cardiac output — the amount of blood the heart can pump out — for which Adempas was, on average, significantly more effective than BPA (0.78 L/min versus 0.33 L/min).

In measurements of exercise tolerance, including six-minute walking distance, and New York Heart Association (NYHA) class, both therapies were effective. But, on average, BPA outperformed Adempas.

Both treatments were reported to be generally well-tolerated. Common side effects of BPA included hemoptysis (coughing up blood), pulmonary edema (fluid in the lungs), and lung injury. Common side effects of Adempas treatment included indigestion, headache, dizziness, hypotension (low blood pressure), and nasopharyngitis (colds).

“Our meta‐analysis indicates that both BPA and riociguat [Adempas] improve pulmonary hemodynamic parameters and exercise tolerance,” the researchers concluded, noting that BPA outperformed Adempas, on average, in most measured parameters.

Nonetheless, according to the team, the “findings need to be confirmed with further multicenter randomized control trials (RCTs) and prospective observational studies.”