Influence of riociguat treatment on pulmonary arterial hypertension A meta-analysis of randomized controlled trials

Background Riociguat treatment might be beneficial for pulmonary arterial hypertension. However, the results of studies to date are controversial. We conducted a systematic review and meta-analysis to explore the influence of riociguat treatment on pulmonary arterial hypertension. Methods The PubMed, Embase, Web of science, EBSCO, and Cochrane Library databases were systematically searched. Randomized controlled trials (RCTs) assessing the effect of riociguat treatment on pulmonary arterial hypertension were included. Two investigators independently searched articles, extracted data, and assessed the quality of included studies. This meta-analysis was performed using the random effects model. Results Seven RCTs were included in the meta-analysis. Compared with a control intervention in pulmonary arterial hypertension, riociguat treatment was able to substantially improve results of the six-minute walking distance (6-MWD; standardized mean difference [SMD] = 0.53; 95% CI = 0.36-0.69; p < 0.00001), EQ-5D score (SMD = 0.35; 95% CI = 0.15-0.54; p = 0.0005), and cardiac index (SMD = 0.94; 95% CI = 0.59-1.29; p < 0.00001). The Living With Pulmonary Hypertension (LPH) score (SMD = -0.33; 95% CI = -0.50-0.17; p < 0.0001) and pulmonary vascular resistance (PVR; SMD = -0.88; 95% CI = -1.05-0.70; p < 0.00001) were significantly reduced after riociguat treatment. There was no increase in adverse events with riociguat treatment compared with the control intervention (RR = 1.04; 95% CI = 0.98-1.09; p = 0.19). Conclusion Riociguat treatment for pulmonary arterial hypertension led to a significant increase in the 6-MWD, EQ-5D score, and cardiac index, as well as a decrease in LPH score and PVR.