Omnia Azmy Nabeh, Alaa I. Saud, Basma Amin, Amira Samy Khedr, Alaa Amr, Aml Medhat Faoosa, Eshraka Esmat, Yasmeen Magdy Mahmoud, Aya Hatem, Mariam Mohamed, Alaa Osama, Youssef Mohamed Amin Soliman, Reem Ibrahim Elkorashy, Soha Aly Elmorsy
{"title":"肺动脉高压新疗法的系统综述。","authors":"Omnia Azmy Nabeh, Alaa I. Saud, Basma Amin, Amira Samy Khedr, Alaa Amr, Aml Medhat Faoosa, Eshraka Esmat, Yasmeen Magdy Mahmoud, Aya Hatem, Mariam Mohamed, Alaa Osama, Youssef Mohamed Amin Soliman, Reem Ibrahim Elkorashy, Soha Aly Elmorsy","doi":"10.1007/s40256-023-00613-5","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>Pulmonary arterial hypertension (PAH) is a progressive, cureless disease, characterized by increased pulmonary vascular resistance and remodeling, with subsequent ventricular dilatation and failure. New therapeutic targets are being investigated for their potential roles in improving PAH patients’ symptoms and reversing pulmonary vascular pathology.</p><h3>Method</h3><p>We aimed to address the available knowledge from the published randomized controlled trials (RCTs) regarding the role of Rho-kinase (ROCK) inhibitors, bone morphogenetic protein 2 (BMP2) inhibitors, estrogen inhibitors, and AMP-activated protein kinase (AMPK) activators on the PAH evaluation parameters. This systematic review (SR) was registered in the International Prospective Register of Systematic Reviews (PROSPERO) database (CDR42022340658) and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.</p><h3>Results</h3><p>Overall, 5092 records were screened from different database and registries; 8 RCTs that met our inclusion criteria were included. The marked difference in the study designs and the variability of the selected outcome measurement tools among the studies made performing a meta-analysis impossible. However, the main findings of this SR relate to the powerful potential of the AMPK activator and the imminent antidiabetic drug metformin, and the BMP2 inhibitor sotatercept as promising PAH-modifying therapies. There is a need for long-term studies to evaluate the effect of the ROCK inhibitor fasudil and the estrogen aromatase inhibitor anastrozole in PAH patients. The role of tacrolimus in PAH is questionable. The discrepancy in the hemodynamic and clinical parameters necessitates defining cut values to predict improvement. The differences in the PAH etiologies render the judgment of the therapeutic potential of the tested drugs challenging.</p><h3>Conclusion</h3><p>Metformin and sotatercept appear as promising therapeutic drugs for PAH.</p><h3>Clinical Trials Registration</h3><p>This work was registered in PROSPERO (CDR42022340658).</p></div>","PeriodicalId":7652,"journal":{"name":"American Journal of Cardiovascular Drugs","volume":"24 1","pages":"39 - 54"},"PeriodicalIF":2.8000,"publicationDate":"2023-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10805839/pdf/","citationCount":"0","resultStr":"{\"title\":\"A Systematic Review of Novel Therapies of Pulmonary Arterial Hypertension\",\"authors\":\"Omnia Azmy Nabeh, Alaa I. Saud, Basma Amin, Amira Samy Khedr, Alaa Amr, Aml Medhat Faoosa, Eshraka Esmat, Yasmeen Magdy Mahmoud, Aya Hatem, Mariam Mohamed, Alaa Osama, Youssef Mohamed Amin Soliman, Reem Ibrahim Elkorashy, Soha Aly Elmorsy\",\"doi\":\"10.1007/s40256-023-00613-5\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><p>Pulmonary arterial hypertension (PAH) is a progressive, cureless disease, characterized by increased pulmonary vascular resistance and remodeling, with subsequent ventricular dilatation and failure. New therapeutic targets are being investigated for their potential roles in improving PAH patients’ symptoms and reversing pulmonary vascular pathology.</p><h3>Method</h3><p>We aimed to address the available knowledge from the published randomized controlled trials (RCTs) regarding the role of Rho-kinase (ROCK) inhibitors, bone morphogenetic protein 2 (BMP2) inhibitors, estrogen inhibitors, and AMP-activated protein kinase (AMPK) activators on the PAH evaluation parameters. This systematic review (SR) was registered in the International Prospective Register of Systematic Reviews (PROSPERO) database (CDR42022340658) and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.</p><h3>Results</h3><p>Overall, 5092 records were screened from different database and registries; 8 RCTs that met our inclusion criteria were included. 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A Systematic Review of Novel Therapies of Pulmonary Arterial Hypertension
Background
Pulmonary arterial hypertension (PAH) is a progressive, cureless disease, characterized by increased pulmonary vascular resistance and remodeling, with subsequent ventricular dilatation and failure. New therapeutic targets are being investigated for their potential roles in improving PAH patients’ symptoms and reversing pulmonary vascular pathology.
Method
We aimed to address the available knowledge from the published randomized controlled trials (RCTs) regarding the role of Rho-kinase (ROCK) inhibitors, bone morphogenetic protein 2 (BMP2) inhibitors, estrogen inhibitors, and AMP-activated protein kinase (AMPK) activators on the PAH evaluation parameters. This systematic review (SR) was registered in the International Prospective Register of Systematic Reviews (PROSPERO) database (CDR42022340658) and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
Results
Overall, 5092 records were screened from different database and registries; 8 RCTs that met our inclusion criteria were included. The marked difference in the study designs and the variability of the selected outcome measurement tools among the studies made performing a meta-analysis impossible. However, the main findings of this SR relate to the powerful potential of the AMPK activator and the imminent antidiabetic drug metformin, and the BMP2 inhibitor sotatercept as promising PAH-modifying therapies. There is a need for long-term studies to evaluate the effect of the ROCK inhibitor fasudil and the estrogen aromatase inhibitor anastrozole in PAH patients. The role of tacrolimus in PAH is questionable. The discrepancy in the hemodynamic and clinical parameters necessitates defining cut values to predict improvement. The differences in the PAH etiologies render the judgment of the therapeutic potential of the tested drugs challenging.
Conclusion
Metformin and sotatercept appear as promising therapeutic drugs for PAH.
Clinical Trials Registration
This work was registered in PROSPERO (CDR42022340658).
期刊介绍：
Promoting rational therapy within the discipline of cardiology, the American Journal of Cardiovascular Drugs covers all aspects of the treatment of cardiovascular disorders, particularly the place in therapy of newer and established agents.
Via a program of reviews and original clinical research articles, the journal addresses major issues relating to treatment of these disorders, including the pharmacology, efficacy and adverse effects of the major classes of drugs; information on newly developed drugs and drug classes; the therapeutic implications of latest research into the aetiology of cardiovascular disorders; and the practical management of specific clinical situations.
The American Journal of Cardiovascular Drugs offers a range of additional enhanced features designed to increase the visibility, readership and educational value of the journal’s content. Each article is accompanied by a Key Points summary, giving a time-efficient overview of the content to a wide readership. Articles may be accompanied by plain language summaries to assist patients, caregivers and others in understanding important medical advances. The journal also provides the option to include various other types of enhanced features including slide sets, videos and animations. All enhanced features are peer reviewed to the same high standard as the article itself. Peer review is conducted using Editorial Manager®, supported by a database of international experts. This database is shared with other Adis journals.
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