| Objective: This systematic review and meta-analysis was conducted to investigate the efficacy and safety of the chronic administration of aerosolized iloprost for pulmonary arterial hypertension(PAH).Methods: All the relevant studies were obtained from 3 databases,namely,PubMed,Web of Science and the Cochrane Library,from the inception of each database to June 1,2018.The rate of each event was analyzed by SPSS as a percentage with 95% confidence intervals(CI).And the meta-analysis was conducted by Stata14.1.Results: Ten studies were enrolled in this study,with a total of 370 patients treated with inhaled iloprost,including 214 in five randomized controlled trials and 156 in five prospective,single-arm clinical trials.Among the patients who received inhaled iloprost,there was a significant improvement in the 6-minute walk distance(6MWD)in the short-medium and prolonged treatment groups.Notably,the functionality improved by at least 1 class in 48.7% of the treated patients.Meta-analysis in hemodynamics indicated a lower mean pulmonary arterial hypertension(mPAP)[SMD=-0.67,95%CI(-1.25,-0.08),P=0.03] and pulmonary vascular resistance(PVR)[SMD:-0.39,95% CI(-0.78,0.004),P=0.048;I2=0.0%] with statistical significance in the first 3 months.Nevertheless,it cannot contribute to a sustained improvement of mPAP and PVR at the endpoints in 6 months and 12 months.In all the pooled studies,the estimated 3-month,6-month,1-year and 2-year event-free survival rates were 96.6%,92.3%,62.6% and 39.6%,respectively.Conclusion: In this systematic review and meta-analysis,inhaled iloprost has been shown to be a safe and well-tolerated agent for PAH in the first 3 months after diagnosis.If used for a prolonged period,aerosol iloprost monotherapy could contribute to an unsatisfactory improvement in vascular remodeling and even a decreased event-free survival rate. |
