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Balloon pulmonary angioplasty and riociguat in the management of chronic thromboembolic pulmonary hypertension: a systematic review

2025-05Journal article Embargoed access
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datacite.subject.sdg03:Saúde de Qualidade
dc.contributor.authorAraújo, Patrícia
dc.contributor.authorCalé, Rita
dc.contributor.authorPereira, Ernesto
dc.contributor.authorFerreira, Filipa
dc.contributor.authorAlegria, Sofia
dc.contributor.authorPereira, Hélder
dc.contributor.authorCoelho, André
dc.date.accessioned2025-06-04T13:51:30Z
dc.date.available2025-06-04T13:51:30Z
dc.date.issued2025-05
dc.description.abstractBackground: No systematic review has been published comparing the effectiveness and safety of balloon pulmonary angioplasty (BPA) and riociguat in patients with chronic thromboembolic pulmonary hypertension (CTEPH) across studies that evaluate both treatment methods. Methods: A literature search was conducted using PubMed, ScienceDirect, and Elsevier. Clinical, functional, and hemodynamic effectiveness criteria were analysed, as well as complications related to both interventions. Results: Five studies were reviewed, including randomized clinical trials and observational studies, comprising 184 patients who underwent riociguat and BPA, 94 patients who underwent BPA alone, and 79 who underwent riociguat alone. Patients receiving combination therapy demonstrated a more significant improvement in WHO-FC, PVR, and CO (≈1.13 L/min) than monotherapy (BPA: ≈0.45 L/min and riociguat: ≈0.84 L/min). Regarding the 6MWD, patients who started with Riociguat before combination therapy showed a greater improvement (≈78 m) than those on monotherapy (BPA: ≈46.9 m and riociguat: ≈38.2 m). The reduction in mPAP was greater in patients treated with BPA alone (≈-17.6 mmHg) compared to riociguat alone (≈-5.4 mmHg) or combination therapy (≈-12.2 mmHg). In the BPA group, the rate of life-threatening complications was very low, with haemoptysis or pulmonary haemorrhage being the most common adverse events (15%-44%). In the riociguat group, dizziness, headaches, gastrointestinal reflux, vomiting, and nausea were reported (15%-23%). Among patients undergoing both treatments, the vascular injury rate was <11 %, with the most common adverse event being the need for non-invasive ventilation (30 %). Conclusions: Combination therapy appears to be more effective than monotherapy, without being associated with major adverse events in patients diagnosed with CTEPH.eng
dc.identifier.citationAraújo P, Calé R, Pereira E, Ferreira F, Alegria S, Coelho A, et al. Balloon pulmonary angioplasty and riociguat in the management of chronic thromboembolic pulmonary hypertension: a systematic review. Respir Med. 2025;244:108154.
dc.identifier.doi10.1016/j.rmed.2025.108154
dc.identifier.issn0954-6111
dc.identifier.urihttp://hdl.handle.net/10400.21/21901
dc.language.isoeng
dc.peerreviewedyes
dc.publisherElsevier
dc.relation.hasversionhttps://www.sciencedirect.com/science/article/pii/S0954611125002161
dc.relation.ispartofRespiratory Medicine
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/4.0/
dc.subjectBalloon pulmonary angioplasty
dc.subjectChronic thromboembolic pulmonary hypertension
dc.subjectEffectiveness
dc.subjectPulmonary vasodilator therapy
dc.subjectSafety
dc.titleBalloon pulmonary angioplasty and riociguat in the management of chronic thromboembolic pulmonary hypertension: a systematic revieweng
dc.typejournal article
dspace.entity.typePublication
oaire.citation.startPage108154
oaire.citation.titleRespiratory Medicine
oaire.citation.volume244
oaire.versionhttp://purl.org/coar/version/c_970fb48d4fbd8a85
person.familyNameFerreira Ramos Coelho
person.givenNameAndré Filipe
person.identifier.ciencia-id291E-1AC6-86FA
person.identifier.orcid0000-0003-1872-8131
relation.isAuthorOfPublicatione00e9fd8-697d-4e70-acd3-e5a5169360ed
relation.isAuthorOfPublication.latestForDiscoverye00e9fd8-697d-4e70-acd3-e5a5169360ed

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