Abstract
Chronic obstructive pulmonary disease-associated pulmonary hypertension (COPD-PH) is an increasingly recognised condition which contributes to worsening dyspnea and poor survival in COPD. It is uncertain whether specific treatment of COPD-PH, including use of medications approved for pulmonary arterial hypertension (PAH), improves clinical outcomes. This systematic review and meta-analysis assesses potential benefits and risks of therapeutic options COPD-PH.
We searched Medline and Embase for relevant publications until Sep 2020. Articles were screened for studies on treatment of COPD-PH for at least 4 weeks in 10 or more patients. Screening, data extraction, and risk of bias assessment were performed independently in duplicate. When possible, relevant results were pooled using the random effects model.
Supplemental long-term O2 therapy (LTOT) mildly reduced mean pulmonary artery pressure (PAP), slowed progression of PH, and reduced mortality, but other clinical or functional benefits were not assessed. Phosphodiesterase type-5 inhibitors significantly improved systolic PAP (pooled treatment effect −5.9 mmHg; 95%CI −10.3, −1.6), but had inconsistent clinical benefits. Calcium-channel blockers and endothelin receptor antagonists had limited hemodynamic, clinical, or survival benefits. Statins had limited clinical benefits despite significantly lowering systolic PAP (pooled treatment effect −4.6 mmHg; 95% CI: −6.3, −2.9).
This review supports guideline recommendations for LTOT in hypoxemic COPD-PH patients as well as recommendations against treatment with PAH-targeted medications, Effective treatment of COPD-PH depends upon research into the pathobiology, and future high-quality studies comprehensively assessing clinically relevant outcomes are needed.
Footnotes
This manuscript has recently been accepted for publication in the ERJ Open Research. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJOR online. Please open or download the PDF to view this article.
Conflict of interest: Ragdah Hussain Arif has nothing to disclose.
Conflict of interest: Arjun Pandey has nothing to disclose.
Conflict of interest: Ying Zhao has nothing to disclose.
Conflict of interest: Kyle Arsenault-Mehta has nothing to disclose.
Conflict of interest: Danya Khoujah has nothing to disclose.
Conflict of interest: Sanjay Mehta reports grants or contracts from Altavant Pharmaceuticals, Eiger Pharmaceuticals, Ikaria Pharmaceuticals, Janssen Pharmaceuticals, Reata Pharmaceuticals, and United Therapeutics, outside the submitted work. Consulting fees from Acceleron Pharmaceuticals, Janssen Pharmaceuticals, and Natco Pharmaceuticals, outside the submitted work. Payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Bayer Pharmaceuticals, Janssen Pharmaceuticals, Natco Pharmaceuticals, and SpecialtyRx Pharmacy, outside the submitted work. Payment for expert testimony from Bergeron Clifford LLP, Lerner Law, and St. Lawrence Barristers LLP, outside the submitted work. Support for attending meetings and/or travel from Janssen Pharmaceuticals, outside the submitted work. Participation on a Data Safety Monitoring Board or Advisory Board for Ozmosis Research. Board Director for Pulmonary Hypertension Association of Canada, unpaid position. Receipt of equipment, materials, drugs, medical writing, gifts or other services from Janssen Pharmaceuticals, outside the submitted work.
This is a PDF-only article. Please click on the PDF link above to read it.
- Received May 29, 2021.
- Accepted September 27, 2021.
- Copyright ©The authors 2021
This version is distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0. For commercial reproduction rights and permissions contact permissions{at}ersnet.org