Efficacy and safety of selexipag, an oral prostacyclin receptor agonist for the treatment of pulmonary hypertension: A meta-analysis

Minshan Chen; Yuanqiang Lai; Riken Chen; Jianmin Lu; Yu Zhang; Haimin Liu; Donghao Wang; Yue Zhong; Zhenzhen Zheng; Cheng Hong

doi:10.1016/j.pupt.2021.102100

Efficacy and safety of selexipag, an oral prostacyclin receptor agonist for the treatment of pulmonary hypertension: A meta-analysis

Pulm Pharmacol Ther. 2022 Feb:72:102100. doi: 10.1016/j.pupt.2021.102100. Epub 2021 Nov 29.

Authors

Affiliations

¹ China State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, China; Department of Clinical Medicine, The First Clinical School of Guangzhou Medical University, China.
² China State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, China.
³ Department of Respiration, The Second Affiliated Hospital of Guangdong Medical University, China. Electronic address: 3342227603@qq.com.
⁴ China State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, China. Electronic address: gyfyyhc@126.com.

PMID: 34856365
DOI: 10.1016/j.pupt.2021.102100

Abstract

Background and objective: This meta-analysis was performed to evaluate the effect and safety of selexipag in the treatment of pulmonary hypertension and to explore the effect of selexipag on cardiac function indexes in PAH patients.

Methods: Electronic databases, including the Cochrane Library, EMBASE, and PubMed databases, were searched. Endnote software X9 was used for study selection, and the Cochrane Risk of Bias Tool was used for literature screening and quality assessment. Data analysis was performed using RevMan 5.3 software, and GRADE was used to assess the evidence level.

Results: Ten studies were finally selected in accordance with the standard. A total of 10 papers were included. A total of 1322 patients were included, including 723 in the trial group and 599 in the control group. Patients with PAH treated with selexipag were included in the trial group, and patients with PAH treated with placebo were included in the control group. The results of the study showed that selexipag was effective in reducing mortality in patients (WMD=0.70, 95% CI: 0.53-0.94, P = 0.02). Selexipag effectively increased the 6-min walk distance (WMD=33.79, 95% CI: 2.69-64.90, P=0.03). Selexipag also effectively increased the 6-min distance between baseline and follow-up (WMD = 15.28, 95% CI: 7.76-22.80, P < 0.0001). Selexipag effectively reduced PVR (WMD = -230.96, 95% CI: 445.94 to -15.97, P = 0.04). Selexipag significantly reduced PVR between baseline and follow-up (WMD = -139.62, 95% CI: 215.32 to -63.91, P = 0.0003). The adverse reactions of selexipag were mild with headache, diarrhea and nausea reported as the main symptoms.

Conclusion: Selexipag is a new drug with mild adverse reactions and is safe for the treatment of PAH. This drug significantly prolongs the level of 6MWD in PAH patients, reduces the fatality rate, improves WHO FC and reduces PVR. The effects of this drug on CI, mPAP, MRAP, SvO₂ and other indicators still need to be further confirmed.

Prospero registration: CRD42021245557.

Keywords: Drug treatment; Meta-analysis; Pulmonary arterial hypertension; Safety; Selexipag.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't
Review

MeSH terms

Acetamides / adverse effects
Antihypertensive Agents* / adverse effects
Humans
Hypertension, Pulmonary* / drug therapy
Pyrazines
Receptors, Epoprostenol* / agonists

Substances

Acetamides
Antihypertensive Agents
Pyrazines
Receptors, Epoprostenol
selexipag