AUTHOR=Li Jie , Yang Zu-Yuan , Wang Shang , Yuan Ping , Zhao Qin-Hua , Gong Su-Gang , Qiu Hong-Ling , Luo Ci-Jun , Li Hui-Ting , Zhang Rui , Wu Wen-Hui , Liu Jin-Ming , Wang Lan , Liu Shan-Shan , Jiang Rong 

TITLE=Efficacy and safety of switching from bosentan or ambrisentan to macitentan in pulmonary arterial hypertension: A systematic review and meta-analysis

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=9

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.977110

DOI=10.3389/fcvm.2022.977110

ISSN=2297-055X

ABSTRACT=<sec><title>Background</title><p>There is little evidence of the effectiveness of switching from the endothelin receptor antagonists (ERAs) bosentan and ambrisentan to a novel ERA, macitentan, in patients with pulmonary arterial hypertension (PAH). Therefore, a systematic review and meta-analysis was performed to evaluate the efficacy and safety of patients with PAH switching from other ERAs to macitentan.</p></sec><sec><title>Methods</title><p>We retrieved the relevant literature published before January 2022 for the meta-analysis from the PubMed, EMBASE, and Cochrane Library databases. Efficacy included changes in the 6-min walk distance (6MWD), World Health Organization functional class (WHO-FC), N-terminal pro-brain natriuretic peptide (NT-proBNP) levels, hemodynamics, echocardiography and survival.</p></sec><sec><title>Results</title><p>Nine studies, consisting of 408 PAH patients, that met the inclusion criteria were included. The switch from bosentan or ambrisentan to macitentan effectively increased the 6MWD by 20.71 m (95% CI: 10.35-31.07, <italic>P</italic> &lt; 0.00001, <italic>I</italic><sup>2</sup> = 0%). Six months after conversion, the tricuspid annular plane systolic excursion was found to improve from 19.0 ± 4.0 to 21.0 ± 5.0 mm in adults and from 16.00 ± 5.0 to 18.25 ± 4.8 mm in children. Ordinal logistic regression showed that the WHO-FC significantly improved by 0.412 (95% CI: 0.187-0.908, <italic>P</italic> = 0.028). The switch did not show significant improvement in NT-proBNP levels. In addition, the switch was well tolerated.</p></sec><sec><title>Conclusion</title><p>The switch from bosentan or ambrisentan to macitentan significantly increased the 6MWD in PAH patients, improved the WHO-FC, and exerted safety benefits. The effects of the switch on NT-proBNP levels, hemodynamics, and echocardiography still need to be further confirmed.</p></sec><sec><title>Systematic review registration</title><p>[<ext-link ext-link-type="uri" xlink:href="https://www.crd.york.ac.uk/prospero/" xmlns:xlink="http://www.w3.org/1999/xlink">https://www.crd.york.ac.uk/prospero/</ext-link>], identifier [CRD42021292554].</p></sec>