Efficacy Between Combination of Ambrisentan and Tadalafil versus Monotherapy in Patients with Pulmonary Arterial Hypertension: Systematic Review

Background: Pulmonary arterial hypertension is a progressive disorder that causes endothelial dysfunction and vascular remodeling that can block small pulmonary arteries resulting in increased pulmonary vascular resistance and pulmonary pressure. Presently ambrisentan or tadalafil is frequently used for pulmonary arterial hypertension as a monotherapy. However, the combination of ambrisentan and tadalafil versus monotherapy remains unclear for pulmonary arterial hypertension. Objective: Hence, this systematic review aims to evaluate the efficacy between ambrisentan plus tadalafil versus monotherapy as a treatment option in patients with pulmonary arterial hypertension. Method: We extracted data from the PubMed Central (PMC), Science Direct, and PubMed databases using keywords ((ambrisentan) AND (tadalafil)) AND (pulmonary arterial hypertension) on December 10th 2023. Eligible studies were selected based on the inclusion and exclusion criteria. Studies included were associated with pulmonary arterial hypertension within the last 5 years, clinical trial, randomized controlled trial, and cohort. We exclude reviews, studies on animal, pediatric patients, case reports and series, meta-analysis, and unavailability of full papers. Then, the quality of studies included was assessed using the JADAD scale. Result: Through inclusion criterias mentioned above, five studies were extracted from six eligible one. We include 5 randomized controlled trials in this systematic review. We assessed all of the studies using the JADAD scale in decent quality at all. Studies included the combination of ambrisentan with tadalafil exhibited better profile than monotherapy in terms of overall survival for pulmonary arterial hypertension patients. Conclusion: It is shown that ambrisentan plus tadalafil is superior compared with monotherapy for pulmonary arterial hypertension.