Comparing the efficacy and safety of medications in adults with hypertrophic cardiomyopathy: a systematic review and network meta-analysis

Keying Mi; Sijia Wu; Chanyuan Lv; Yongkang Meng; Wenchao Yin; Hongkai Li; Jiangbing Li; Haitao Yuan

doi:10.3389/fcvm.2023.1190181

Comparing the efficacy and safety of medications in adults with hypertrophic cardiomyopathy: a systematic review and network meta-analysis

Front Cardiovasc Med. 2023 Aug 14:10:1190181. doi: 10.3389/fcvm.2023.1190181. eCollection 2023.

Authors

Keying Mi^#^{1

2}, Sijia Wu^#^{3

4}, Chanyuan Lv^{1

2}, Yongkang Meng^{1

2}, Wenchao Yin^{1

2}, Hongkai Li^{3

4}, Jiangbing Li^{1

2

5}, Haitao Yuan^{1

2

5}

Affiliations

¹ Department of Cardiology, Shandong Provincial Hospital, Shandong University, Jinan, China.
² JiNan Key Laboratory of Cardiovascular Disease, Jinan, China.
³ Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China.
⁴ Institute for Medical Dataology, Cheeloo College of Medicine, Shandong University, Jinan, China.
⁵ Department of Cardiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China.

^# Contributed equally.

Abstract

Background: Hypertrophic cardiomyopathy (HCM) is the most common genetic heart disease. The purpose of this study was to evaluate the efficacy and safety of several medications and recommend better drug treatments for adults with HCM.

Methods: A review of PubMed, Embase, the Cochrane Controlled Register of Trials (CENTRAL), ClinicalTrials.gov and CNKI databases was conducted for studies on the efficacy and safety of drugs for adults with HCM. A frequentist random effects model was used in this network analysis.

Results: This network meta-analysis included 7 studies assessing seven medications, 6 studies evaluating monotherapy and 1 study evaluating combination therapy. Based on the network meta-analysis results, xiaoxinbi formula plus metoprolol (MD -56.50% [-72.43%, -40.57%]), metoprolol (MD -47.00% [-59.07%, -34.93%]) and mavacamten (MD -34.50% [-44.75%, -24.25%]) significantly reduced the resting left ventricular outflow tract gradient (LVOTG) in comparison with placebo. Resting LVOTG could also be reduced with N-acetylcysteine (NAC). The incidence of adverse drug reactions was not significantly different between the placebo group and the treatment group.

Conclusion: For adults with HCM, the top 4 treatments included xiaoxinbi formula plus metoprolol, metoprolol, mavacamten and NAC.Systematic Review Registration: [https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=374222], identifier [CRD42022374222].

Keywords: frequentist network meta-analysis; hypertrophic cardiomyopathy; left ventricular outflow tract gradient; medications; system review and meta-analysis.

Publication types

Review

Grants and funding

This work was supported by the 2021 Shandong Medical Association Clinical Research Fund—Qilu Special Project (grant numbers YXH2022DZX02008); XinXin Heart Foundation of SIP-China Cardiovascular Association ATTR-CM fund (grant numbers 2022-CCA-ATTR-CM-014).