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Table 35Summary of strength of evidence and effect estimates for monotherapy versus combination therapy for PAH (KQ 3)a

InterventionMortality6MWD (m)Hospitalization
Endothelin antagonist vs. placeboSOE = Insufficient
(6 studies, 838 patients)

Inconclusive benefit (few studies, few deaths lead to wide CI)

OR 0.60 (95% CI, 0.23 to 1.59)
SOE = Moderate
(6 studies, 663 patients)

Improved 6MWD with endothelin antagonists compared with placebo

Mean difference 39.9 (95% CI, 21.4 to 58.4)
SOE = Moderate
(3 studies, 606 patients)

Reduced risk of hospitalization

OR 0.34 (95% CI, 0.17 to 0.69)
Phosphodiesterase inhibitors vs. placeboSOE = Insufficient
(4 studies, 1,011 patients)

Inconclusive benefit (few studies, few deaths lead to wide CI)

OR 0.30 (95% CI, 0.08 to 1.11)
SOE = Moderate
(4 studies, 991 patients)

Improved 6MWD with PDE5 therapy compared with placebo or standard therapy

Mean difference 38.9 (95% CI, 22.0 to 55.9)
SOE = Moderate
(4 studies, 1,011 patients)

Reduced risk of hospitalization

OR 0.48 (95% CI, 0.25 to 0.91)
Prostanoids vs. placebo or standard therapySOE = Low
(8 studies, 1,229 patients)

Lower mortality with prostanoids, but inconsistent results and wide CI

OR 0.52 (95% CI, 0.29 to 0.95)
SOE = Moderate
(7 studies, 933 patients)

Improved 6MWD with prostanoid therapy compared with placebo

Mean difference 27.9 (95% CI, 10.3 to 45.4)
SOE = Insufficient
(2 studies, 301 patients)

Inconclusive benefit (few studies, wide CI)

OR 0.42 (95% CI, 0.06 to 3.08)
Combination vs. monotherapySOE = Insufficient
(3 studies, 566 patients)

Inconclusive benefit (few studies, few deaths lead to wide CI)

OR 0.37 (95% CI, 0.04 to 3.32)
SOE = Low
(3 studies, 363 patients)

Improved 6MWD with combination therapy compared with monotherapy

Mean difference 23.9 (95% CI, 8.0 to 39.9)
SOE = Insufficient
(3 studies, 566 patients)

Inconclusive benefit (few studies, wide CI)

OR 0.64 (95% CI, 0.31 to 1.36)

6MWD = 6-minute walk distance; CI = confidence interval; NS = not statistically significant; OR = odds ratio; SOE=strength of evidence

a

Gray background indicates insufficient SOE.

Gray background indicates insufficient SOE.

From: Discussion

Cover of Pulmonary Arterial Hypertension: Screening, Management, and Treatment
Pulmonary Arterial Hypertension: Screening, Management, and Treatment [Internet].
Comparative Effectiveness Reviews, No. 117.
McCrory DC, Coeytaux RR, Schmit KM, et al.

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