Cochrane · systematic review · CD012621
Phosphodiesterase 5 inhibitors for pulmonary hypertension
Barnes, H, Brown, Z, Burns, A, et al. · Cochrane Database of Systematic Reviews · 2019 · Cochrane Library
AirwaysAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
54
current version
GRADE rated
50
No studies
3
Included studies
NR
No studies 3 · 5.6%Ungraded 1 · 1.9%Very low 0 · 0%Low 19 · 35.2%Moderate 23 · 42.6%High 8 · 14.8%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Group 1 Pulmonary arterial hypertension ‐ PDE5i compared to placebo
Population: people with pulmonary arterial hypertension
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Improvement in WHO functional class Group 1 Pulmonary arterial hypertension ‐ PDE5i vs placebo | OR 8.59 [3.95, 18.72] | 4 studies · 282 participants | High |
Six‐minute walk distance Group 1 Pulmonary arterial hypertension ‐ PDE5i vs placebo | no estimate extracted | 8 studies · 880 participants | Moderate Downgraded: imprecision, inconsistency |
Mortality Group 1 Pulmonary arterial hypertension ‐ PDE5i vs placebo | OR 0.22 [0.07, 0.68] | 8 studies · 1119 participants | High |
Quality of life SF‐36: (scores 1 to 100, higher scores indicate better QoL) EQ‐5D questionnaire: (higher scores indicate worse QoL) CHFQ: (lower scores indicate worse QoL) Group 1 Pulmonary arterial hypertension ‐ PDE5i vs placebo | no estimate extracted | 2 studies · 163 participants | Ungraded |
PAP Group 1 Pulmonary arterial hypertension ‐ PDE5i vs placebo | no estimate extracted | 6 studies · 453 participants | Moderate Downgraded: imprecision, inconsistency |
RAP Group 1 Pulmonary arterial hypertension ‐ PDE5i vs placebo | no estimate extracted | 3 studies · 341 participants | High |
Cardiac index Group 1 Pulmonary arterial hypertension ‐ PDE5i vs placebo | no estimate extracted | 4 studies · 239 participants | Moderate Downgraded: imprecision, inconsistency |
PVR Group 1 Pulmonary arterial hypertension ‐ PDE5i vs placebo | no estimate extracted | 3 studies · 266 participants | High |
Group 1 Pulmonary arterial hypertension ‐ PDE5i compared to placebo, on combination therapy
Population: people with pulmonary arterial hypertension
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Improvement in WHO functional class Group 1 Pulmonary arterial hypertension ‐ PDE5i vs placebo, on combination therapy | OR 1.2 [0.66, 2.17] | 2 studies · 227 participants | Moderate Downgraded: imprecision, inconsistency |
Six‐minute walk distance Group 1 Pulmonary arterial hypertension ‐ PDE5i vs placebo, on combination therapy | no estimate extracted | 4 studies · 509 participants | Moderate Downgraded: imprecision, inconsistency |
Mortality Group 1 Pulmonary arterial hypertension ‐ PDE5i vs placebo, on combination therapy | OR 0.26 [0.07, 1.06] | 3 studies · 492 participants | Moderate Downgraded: imprecision |
Quality of life physical functioning on SF‐36 (higher scores indicate better quality of life) Group 1 Pulmonary arterial hypertension ‐ PDE5i vs placebo, on combination therapy | no estimate extracted | 1 study · 267 participants | Moderate Downgraded: imprecision |
PAP Group 1 Pulmonary arterial hypertension ‐ PDE5i vs placebo, on combination therapy | no estimate extracted | 2 studies · 387 participants | High |
Cardiac output Group 1 Pulmonary arterial hypertension ‐ PDE5i vs placebo, on combination therapy | no estimate extracted | 3 studies · 310 participants | High |
PVR Group 1 Pulmonary arterial hypertension ‐ PDE5i vs placebo, on combination therapy | no estimate extracted | 3 studies · 303 participants | High |
Group 1 Pulmonary arterial hypertension ‐ PDE5i compared to ERA
Population: people with pulmonary arterial hypertension
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Improvement in WHO functional class Group 1 Pulmonary arterial hypertension ‐ PDE5i vs ERA | OR 0.94 [0.55, 1.6] | 1 study · 244 participants | Moderate Downgraded: imprecision |
Six‐minute walk distance Group 1 Pulmonary arterial hypertension ‐ PDE5i vs ERA | no estimate extracted | 2 studies · 36 participants | Low Downgraded: imprecision |
Mortality Group 1 Pulmonary arterial hypertension ‐ PDE5i vs ERA | OR 3.19 [0.74, 13.64] | 2 studies · 272 participants | Moderate Downgraded: imprecision |
Quality of life Kansas City Cardiomyopathy Quality‐of‐Life questionnaire (higher scores indicate better quality of life) Group 1 Pulmonary arterial hypertension ‐ PDE5i vs ERA | no estimate extracted | 1 study · 25 participants | Low Downgraded: imprecision |
PAP Group 1 Pulmonary arterial hypertension ‐ PDE5i vs ERA | no estimate extracted | 1 study · 11 participants | Low Downgraded: risk of bias |
RAP Group 1 Pulmonary arterial hypertension ‐ PDE5i vs ERA | no estimate extracted | 1 study · 11 participants | Low Downgraded: risk of bias |
Cardiac index Group 1 Pulmonary arterial hypertension ‐ PDE5i vs ERA | no estimate extracted | 1 study · 11 participants | Low Downgraded: risk of bias |
PVR Group 1 Pulmonary arterial hypertension ‐ PDE5i vs ERA | no estimate extracted | 1 study · 11 participants | Low Downgraded: risk of bias |
Group 2 Pulmonary hypertension due to left‐heart disease ‐ PDE5i compared to placebo
Population: people with pulmonary hypertension due to left‐heart disease
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Improvement in WHO functional class Group 2 Pulmonary hypertension due to left‐heart disease ‐ PDE5i vs placebo | OR 0.53 [0.32, 0.87] | 3 studies · 285 participants | Moderate Downgraded: inconsistency |
Six‐minute walk distance Group 2 Pulmonary hypertension due to left‐heart disease ‐ PDE5i vs placebo | no estimate extracted | 3 studies · 284 participants | Moderate Downgraded: inconsistency |
Mortality Group 2 Pulmonary hypertension due to left‐heart disease ‐ PDE5i vs placebo | OR 1.27 [0.28, 5.8] | 3 studies · 286 participants | Moderate Downgraded: imprecision |
Quality of life Group 2 Pulmonary hypertension due to left‐heart disease ‐ PDE5i vs placebo | no estimate extracted | 1 study · 52 participants | Low Downgraded: imprecision |
Mean PAP Group 2 Pulmonary hypertension due to left‐heart disease ‐ PDE5i vs placebo | no estimate extracted | 3 studies · 130 participants | Moderate Downgraded: inconsistency |
Cardiac index Group 2 Pulmonary hypertension due to left‐heart disease ‐ PDE5i vs placebo | no estimate extracted | 2 studies · 96 participants | Moderate Downgraded: inconsistency |
Group 3 Pulmonary hypertension due to lung disease ‐ PDE5i compared to placebo
Population: people with pulmonary hypertension due to lung disease
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Improvement in WHO functional class Group 3 Pulmonary hypertension due to lung disease ‐ PDE5i vs placebo | OR 44.33 [4.78, 410.94] | 1 study · 40 participants | Low Downgraded: imprecision |
Six‐minute walk distance Group 3 Pulmonary hypertension due to lung disease ‐ PDE5i vs placebo | no estimate extracted | 5 studies · 350 participants | High |
Mortality Group 3 Pulmonary hypertension due to lung disease ‐ PDE5i vs placebo | no estimate extracted | NR | No studies |
Quality of life Group 3 Pulmonary hypertension due to lung disease ‐ PDE5i vs placebo | no estimate extracted | 2 studies · 238 participants | Moderate Downgraded: imprecision |
Mean PAP Group 3 Pulmonary hypertension due to lung disease ‐ PDE5i vs placebo | no estimate extracted | 2 studies · 61 participants | Moderate Downgraded: imprecision |
Cardiac index Group 3 Pulmonary hypertension due to lung disease ‐ PDE5i vs placebo | no estimate extracted | 1 study · 28 participants | Low Downgraded: imprecision |
PVR Group 3 Pulmonary hypertension due to lung disease ‐ PDE5i vs placebo | no estimate extracted | 1 study · 28 participants | Low Downgraded: imprecision |
RAP Group 3 Pulmonary hypertension due to lung disease ‐ PDE5i vs placebo | no estimate extracted | 1 study · 28 participants | Low Downgraded: imprecision |
Group 4 Pulmonary hypertension due to CTEPH ‐ PDE5i compared to placebo
Population: people with pulmonary hypertension due to CTEPH
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Improvement in WHO functional class Group 4 Pulmonary hypertension due to CTEPH ‐ PDE5i vs placebo | OR 17.18 [0.78, 380.84] | 1 study · 19 participants | Low Downgraded: imprecision |
Six‐minute walk distance ‐ sildenafil compared to placebo Group 4 Pulmonary hypertension due to CTEPH ‐ PDE5i vs placebo | no estimate extracted | 1 study · 19 participants | Low Downgraded: imprecision |
Six‐minute walk distance ‐ sildenafil compared to bosentan Group 4 Pulmonary hypertension due to CTEPH ‐ PDE5i vs placebo | no estimate extracted | 2 studies · 227 participants | Moderate Downgraded: imprecision |
Mortality ‐ sildenafil versus placebo Group 4 Pulmonary hypertension due to CTEPH ‐ PDE5i vs placebo | no estimate extracted | 1 study · 20 participants | Low Downgraded: imprecision |
Mortality ‐ sildenafil versus bosentan Group 4 Pulmonary hypertension due to CTEPH ‐ PDE5i vs placebo | OR 1.36 [0.22, 8.48] | 1 study · 106 participants | Low Downgraded: imprecision |
Quality of life Group 4 Pulmonary hypertension due to CTEPH ‐ PDE5i vs placebo | no estimate extracted | 1 study · 34 participants | Low Downgraded: imprecision |
Mean PAP ‐ sildenafil versus placebo Group 4 Pulmonary hypertension due to CTEPH ‐ PDE5i vs placebo | no estimate extracted | 1 study · 19 participants | Low Downgraded: imprecision |
Mean PAP ‐ sildenafil versus bosentan Group 4 Pulmonary hypertension due to CTEPH ‐ PDE5i vs placebo | no estimate extracted | 2 studies · 227 participants | Moderate Downgraded: imprecision |
Cardiac index ‐ sildenafil versus placebo Group 4 Pulmonary hypertension due to CTEPH ‐ PDE5i vs placebo | no estimate extracted | 1 study · 19 participants | Low Downgraded: imprecision |
Cardiac index ‐ sildenafil versus bosentan Group 4 Pulmonary hypertension due to CTEPH ‐ PDE5i vs placebo | no estimate extracted | 2 studies · 227 participants | Moderate Downgraded: imprecision |
PVR ‐ sildenafil versus placebo Group 4 Pulmonary hypertension due to CTEPH ‐ PDE5i vs placebo | no estimate extracted | 1 study · 19 participants | Low Downgraded: imprecision |
PVR ‐ sildenafil versus bosentan Group 4 Pulmonary hypertension due to CTEPH ‐ PDE5i vs placebo | no estimate extracted | 2 studies · 227 participants | Moderate Downgraded: imprecision |
Mixed Pulmonary hypertension group 2 ‐ 4 ‐ PDE5i compared to placebo
Population: people with pulmonary hypertension group 2 ‐ 4
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Improvement in WHO functional class Mixed Pulmonary hypertension group 2 ‐ 4 ‐ PDE5i vs placebo | OR 11.31 [4.9, 26.14] | 2 studies · 146 participants | Moderate Downgraded: risk of bias, imprecision |
Six‐minute walk distance Mixed Pulmonary hypertension group 2 ‐ 4 ‐ PDE5i vs placebo | no estimate extracted | 1 study · 106 participants | Moderate Downgraded: risk of bias, imprecision |
Mortality Mixed Pulmonary hypertension group 2 ‐ 4 ‐ PDE5i vs placebo | no estimate extracted | NR | No studies |
Quality of life Mixed Pulmonary hypertension group 2 ‐ 4 ‐ PDE5i vs placebo | no estimate extracted | NR | No studies |
PASP Mixed Pulmonary hypertension group 2 ‐ 4 ‐ PDE5i vs placebo | no estimate extracted | 2 studies · 146 participants | Moderate Downgraded: risk of bias, imprecision |