5型磷酸二酯酶抑制剂治疗肺动脉高压的网状meta分析

Network meta-analysis of phosphodiesterase type 5 inhibitors for pulmonary hypertension

目的采用网状meta分析比较西地那非、伐地那非、他达那非3种5型磷酸二酯酶抑制剂治疗肺动脉高压的疗效和安全性。方法计算机检索PubMed、the Cochrane Library、EMbase和中国生物医学文献数据库、中国知网、维普、万方数据库,检索时间截止至2020年7月,纳入3种5型磷酸二酯酶抑制剂治疗肺动脉高压的随机对照试验,结局指标为疗效、临床恶化率、药物相关不良反应。由两位研究员先筛选文献、再提取资料并评价纳入研究,然后使用RevMan 5.3软件和GEMTC软件来进行直接和网络meta分析。结果共纳入14篇随机对照研究,共1584名患者。直接meta分析结果显示,3种5型磷酸二酯酶抑制剂的疗效都优于对照组;西地那非和伐地那非能显著降低临床恶化率;伐地那非和他达那非组药物不良反应发生率增加。网状meta分析结果显示,在疗效方面,等级概率图显示他达那非最佳,其次为西地那非,伐地那非;在改善临床恶化率方面,最优为伐地那非,其次为西地那非、他达那非;在药物相关不良反应方面,西地那非、伐地那非较他达那非不良反应发生率高。结论在3种5型磷酸二酯酶抑制剂中,他达那非的疗效较西地那非和伐地那非更佳,药物不良反应发生率更低,但是在改善临床恶化率方面不如西地那非和伐地那非。

Objective To compare the efficacy and safety of 3 phosphodiesterase type 5 inhibitors(sildenafil,vardenafil and tadanafil)in the treatment of pulmonary hypertension by network metaanalysis.Methods PubMed,the Cochrane Library,EMbase and Chinese biomedical literature database,CNKI,VIP,and Wanfang were researched up to July 2020.Randomized controlled trials with 3 phosphodiesterase type 5 inhibitors for pulmonary hypertension were included.The main outcome indicators for curative effect,clinical deterioration rate,and drug related adverse reactions were compared.After the two researchers screened the literature,the data were extracted and evaluated,and the direct and network meta-analysis was conducted by RevMan 5.3 software and GEMTC.Results Totally 14 randomized controlled studies with 1584 patients were included.The direct meta-analysis showed that the efficacy of the 3 phosphodiesterase type 5 inhibitors was better than that of the control group.Sildenafil and vardenafil significantly reduced the clinical deterioration rate.The incidence of adverse drug reactions was increased in the vardenafil and the tadanafil groups.The reticular meta-analysis showed that in terms of efficacy,the hierarchical probability graph showed that tadanafil was the best,followed by sildenafil and vardenafil.As for improved clinical deterioration rate,vardenafil was the best,followed by sildenafil and tadanafil.Sildenafil and vardenafil had a higher incidence of adverse reactions than tardanafil.Conclusion Among the 3 phosphodiesterase type 5 inhibitors,tadanafil is more effective than sildenafil and vardenafil,with a lower incidence of adverse drug reactions,but not as effective as sildenafil and vardenafil in improving clinical deterioration.