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Meta-Analysis
. 2023 Nov;17(11):1117-1129.
doi: 10.1111/crj.13621. Epub 2023 Jul 10.

Efficacy and safety of macitentan for pulmonary hypertension: A meta-analysis

Dan Du  1 , Ya-Dong Yuan  2
Affiliations
Meta-Analysis

Efficacy and safety of macitentan for pulmonary hypertension: A meta-analysis

Dan Du et al. Clin Respir J. 2023 Nov.

Abstract

Introduction: Our purpose of this study is to evaluate the effect and safety of macitentan in the treatment of pulmonary hypertension (PH).

Methods: We retrieved the safety and efficacy of macitentan treatment for PH using PubMed, the Cochrane Library, EMBASE databases and clinicaltrials.gov. The Cochrane Risk of Bias Tool was used for literature screening and quality assessment. Data analysis was conducted using RevMan 5.4.1 and Stata/SE 15.1 software. Results are presented as standardization mean differences (SMDs) and odds ratio (OR).

Results: Meta-analysis of seven randomized controlled trial (RCT) studies and four non-RCT studies with 2769 patients was included, involving 723 in the macitentan group and 599 in the placebo group. The results of the study showed that macitentan had effectively decreased pulmonary vascular resistance (PVR) (SMD = -0.53, 95% CI: -0.77--0.29, p < 0.05), cardiac index (CI) (SMD = 0.60, 95% CI: 0.37-0.83, p < 0.05) and N-terminal pro-brain natriuretic peptide (NT-proBNP) (SMD = -0.22, 95% CI: -0.40--0.03, p < 0.05). Furthermore, macitentan also significantly reduced PVR (SMD = -0.58, 95% CI: -0.80--0.35, p < 0.05), 6-min walk distance (6WMD) (SMD = 0.33, 95% CI: 0.15-0.50, p < 0.05), CI (SMD = 0.48, 95% CI: 0.28-0.69, p < 0.05), mean pulmonary arterial pressure (mPAP) (SMD = -0.43, 95% CI: -0.64--0.23, p < 0.05) and NT-proBNP (SMD = -0.55, 95% CI: -1.07--0.03, p < 0.05) between baseline and follow-up. The adverse reactions to macitentan were mild, with headache, anaemia and bronchitis. Other efficacy and safety outcomes did not reach statistical differences.

Conclusion: Macitentan therapy for PH is effective and safe. The effectiveness on PVR, mPAP, mean right atrial pressure (mRAP), mortality and other indicators still needs to be further confirmed.

Keywords: efficacy; macitentan; meta-analysis; pulmonary hypertension; safety.

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Figures

FIGURE 1
FIGURE 1
Literature retrieve flow diagram.
FIGURE 2
FIGURE 2
Literature quality assessment.
FIGURE 3
FIGURE 3
Meta‐analysis of the effects of macitentan versus placebo on pulmonary vascular resistance (PVR).
FIGURE 4
FIGURE 4
Meta‐analysis of the effects of follow‐up versus baseline on pulmonary vascular resistance (PVR).
FIGURE 5
FIGURE 5
Meta‐analysis of the effects of macitentan versus placebo on 6‐min walk distance (6WMD).
FIGURE 6
FIGURE 6
Meta‐analysis of the effects of follow‐up versus baseline on 6‐min walk distance (6WMD).
FIGURE 7
FIGURE 7
Meta‐analysis of the effects of macitentan versus placebo on mean pulmonary arterial pressure (mPAP).
FIGURE 8
FIGURE 8
Meta‐analysis of the effects of follow‐up versus baseline on mean pulmonary arterial pressure (mPAP).
See this image and copyright information in PMC

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