Evidence map›Paper›PMID 38416633›Full record

ArticleEuropean heart journal2024

Pulmonary arterial hypertension treatment: an individual participant data network meta-analysis.

Jude Moutchia, Robyn L McClelland, Nadine Al-Naamani, Dina H Appleby, John H Holmes, Jasleen Minhas, Jeremy A Mazurek, Harold I Palevsky, Corey E Ventetuolo, Steven M Kawut

Open access · greenAbstract readNetwork Meta-Analysis
In one paragraph

Article in European heart journal, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
21citing papers in PubMed, 2 pooled it
9.6field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

21 citing papers in PubMed, 2 syntheses or guidelines pooled it, 23 citations in OpenAlex.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors at 3 institutions in 1 country.

Jude MoutchiaDepartment of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.ORCID 0000-0002-4892-9471
Robyn L McClellandDepartment of Biostatistics, School of Public Health, University of Washington, Seattle, WA, USA.
Nadine Al-NaamaniDepartment of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Dina H ApplebyDepartment of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
John H HolmesDepartment of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Jasleen MinhasDepartment of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Jeremy A MazurekDepartment of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Harold I PalevskyDepartment of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Corey E VentetuoloDepartment of Medicine and Health Services, Policy and Practice, Brown University, Providence, RI, USA.
Steven M KawutDepartment of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
University of Pennsylvania · USBrown University · USUniversity of Washington · US

Funding

Cardiology & pulmonary research training grantT32HL007891 · NHLBI · UNIVERSITY OF PENNSYLVANIA · PI Jason D Christie · 1998 to 2026
$12.0M
Mentored Patient-Oriented Research in Pulmonary Arterial HypertensionK24HL103844 · NHLBI · UNIVERSITY OF PENNSYLVANIA · PI KAWUT, STEVEN M · 2011 to 2020
$1.6M
Obesity in Pulmonary Arterial HypertensionK23HL141584 · NHLBI · UNIVERSITY OF PENNSYLVANIA · PI AL-NAAMANI, NADINE · 2018 to 2022
$970k
Cardiovascular Medical Research and Education FundNHLBI NIH HHS K23 HL141584NHLBI NIH HHS K24 HL103844NHLBI NIH HHS T32 HL007891NIH HHS K24 HL103844
6 · The paper itself

Abstract

BACKGROUND AND

aimsEffective therapies that target three main signalling pathways are approved to treat pulmonary arterial hypertension (PAH). However, there are few large patient-level studies that compare the effectiveness of these pathways. The aim of this analysis was to compare the effectiveness of the treatment pathways in PAH and to assess treatment heterogeneity.

methodsA network meta-analysis was performed using individual participant data of 6811 PAH patients from 20 Phase III randomized clinical trials of therapy for PAH that were submitted to the US Food and Drug Administration. Individual drugs were grouped by the following treatment pathways: endothelin, nitric oxide, and prostacyclin pathways.

resultsThe mean (±standard deviation) age of the sample was 49.2 (±15.4) years; 78.4% were female, 59.7% had idiopathic PAH, and 36.5% were on background PAH therapy. After covariate adjustment, targeting the endothelin + nitric oxide pathway {β: 43.7 m [95% confidence interval (CI): 32.9, 54.4]}, nitric oxide pathway [β: 29.4 m (95% CI: 22.6, 36.3)], endothelin pathway [β: 25.3 m (95% CI: 19.8, 30.8)], and prostacyclin pathway [oral/inhaled β: 19.1 m (95% CI: 14.2, 24.0), intravenous/subcutaneous β: 24.4 m (95% CI: 15.1, 33.7)] significantly increased 6 min walk distance at 12 or 16 weeks compared with placebo. Treatments also significantly reduced the likelihood of having clinical worsening events. There was significant heterogeneity of treatment effects by age, body mass index, hypertension, diabetes, and coronary artery disease.

conclusionsDrugs targeting the three traditional treatment pathways significantly improve outcomes in PAH, with significant treatment heterogeneity in patients with some comorbidities. Randomized clinical trials are warranted to identify the most effective treatment strategies in a personalized approach.

Indexed as

Antihypertensive AgentsClinical Trials, Phase III as TopicEndothelinsEpoprostenolFemaleHumansHypertension, PulmonaryMaleMiddle AgedNitric OxidePulmonary Arterial HypertensionRandomized Controlled Trials as TopicTreatment OutcomeAntihypertensive AgentsEndothelinsEpoprostenolNitric OxideComparative effectivenessNetwork meta-analysisPulmonary arterial hypertensionTreatment heterogeneityTreatment pathway

Identifiers

PMID38416633
PMCPMC11143388
OpenAlexW4392242768

What Socratic holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.