Prostacyclins show promise as CTEPH treatment: Meta-analysis
Researchers pooled data from 6 studies covering 387 patients
Treatments that target the prostacyclin pathway hold promise as chronic thromboembolic pulmonary hypertension (CTEPH) treatment for patients who aren’t eligible for surgery, but more data is needed to verify the effectiveness of these medications in this type of pulmonary hypertension, according to the authors of a meta-analysis of previous studies.
“In the era of multimodal CTEPH treatment, prostacyclin pathway vasodilators present therapeutic potential for the specific subgroup of CTEPH patients,” the researchers wrote. “However, the current clinical evidence remains insufficient and controversial, necessitating further validation through larger-scale studies.”
The study, “Prostacyclin pathway vasodilators in patients with chronic thromboembolic pulmonary hypertension (CTEPH): A systemic review and meta-analysis of randomized controlled trials,” was published in Pulmonary Circulation.
CTEPH is a form of pulmonary hypertension in which clots cause high blood pressure in the lungs, which puts strain on the heart. The usual first-line treatment involves surgery. But this isn’t always an option, and it doesn’t always work perfectly. Some people with CTEPH may require medications to manage their disease.
Prostacyclin is a signaling molecule that can reduce blood pressure by prompting blood vessels to relax and widen. Several medications that mimic the activity of prostacyclin are approved to treat pulmonary arterial hypertension (PAH), but data on their use in CTEPH has so far been inconsistent.
6 trials, 3 drugs, 387 patients
Here, researchers conducted a meta-analysis to review current data on the use of prostacyclin modulators in CTEPH. Meta-analysis is a type of research in which scientists pool data from multiple previous studies and analyze the data collectively.
This analysis included data from six clinical trials involving a total of 387 CTEPH patients, most of whom were not eligible for surgery or had persistent/recurrent pulmonary hypertension after surgery. Across the studies, three different prostacyclin drugs were tested: oral selexipag (sold for PAH as Uptravi), inhaled iloprost (sold as Ventavis), and under-the-skin injection treprostinil (sold as Remodulin).
Results generally indicated that these prostacyclin medications showed positive effects in CTEPH patients. For example, data showed the treatments induced a significant decrease in pulmonary vascular resistance, a measure of how much force it takes to move blood through the lungs, and reduced the number of patients who improved their World Health Organization functional class.
Prostacyclin therapy also significantly reduced levels of NT-proBNP, a marker of heart damage, improved right atrial pressure, the filling pressure of the right heart, and led to benefits in cardiac index, a measure of heart function.
The distance patients could walk in six minutes, a common measure of exercise capacity, also tended to show improvements with prostacyclin therapies.
Safety data showed the prostacyclin therapies were typically well tolerated. Most reported side effects were mild, and serious safety problems were infrequent.
The researchers said the data on prostacyclin drugs in CTEPH is so far promising, but more studies are needed to verify whether this class of therapy can benefit people with CTEPH, especially those who aren’t eligible for surgeries.
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