Efficacy and safety of endothelin receptor antagonists, phosphodiesterase type 5 Inhibitors, and prostaglandins in pediatric pulmonary arterial hypertension: A network meta-analysis.
Level 1 - systematic review of randomized trials
Systematic review and network meta-analysis of randomized controlled trials
PubMed 36712266 · doi:10.3389/fcvm.2022.1055897
What was done
A systematic review and network meta-analysis of randomized controlled trials (RCTs) searched PubMed, EMBASE, Web of Science, and Cochrane Library through April 12, 2022. It compared endothelin receptor antagonists (ERAs), phosphodiesterase type 5 inhibitors (PDE-5i), and prostaglandins (ProsA) in pediatric pulmonary arterial hypertension (PAH). Outcomes evaluated included six hemodynamic parameters, four respiratory parameters, ICU stay duration, hospital stay duration, and two safety outcomes across 27 RCTs with 1,574 pediatric participants.
What was found
The abstract reports no numerical values, effect sizes, or confidence intervals. It reports that mechanical ventilation duration was shorter with bosentan, sildenafil, and ProsA versus placebo; bosentan shortened ventilation duration more than ProsA, and ProsA shortened it more than sildenafil. For ICU length of stay, ProsA and sildenafil shortened stay compared to placebo, with ProsA being more effective than sildenafil. For safety, sildenafil showed a statistically significant difference compared with placebo and surpassed ProsA in reducing pulmonary hypertension crisis incidence.
Why it matters
This study provides comparative hierarchy across major drug classes in pediatric PAH, showing differential advantages for recovery metrics (ERAs, prostaglandins) versus crisis prevention (PDE-5 inhibitors).
Limits
The abstract omits all numerical point estimates, variance, and confidence intervals. Findings across the six hemodynamic and four respiratory parameters mentioned in the methods are not detailed in the abstract. Heterogeneity in pediatric PAH etiology, drug dosing regimens, and trial risk of bias are not reported.
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