Key result
PDE-5 inhibitors did not significantly improve 6-minute walk distance (MD 22.06 m; 95% CI -5.80 to 49.91) in COPD patients, despite a significant reduction in mean pulmonary artery pressure.
Why the study?
Chronic obstructive pulmonary disease is a major global healthcare burden, but the effects of PDE-5 inhibitors on clinical outcomes and haemodynamic parameters in these patients required determination.
Do PDE-5 inhibitors improve exercise capacity and haemodynamic parameters in patients with COPD?
Meta-Analysis (n=414)
Do PDE-5 inhibitors improve exercise capacity and haemodynamic parameters in patients with COPD?
Mean Difference: 22.06 (95% CI -5.8–49.91)
PDE-5 inhibitors do not improve exercise capacity in COPD patients, despite some improvements in pulmonary hemodynamics, and are associated with increased headaches.
PDE-5 inhibitors do not improve 6MWD in COPD; confirms limited role for exercise capacity while modestly lowering mPAP.
Chronic obstructive pulmonary disease (COPD) is a major burden of healthcare worldwide. We aimed to determine the effects of PDE-5 inhibitors on clinical outcomes and haemodynamic parameters in patients with COPD. A PROSPERO-registered systematic review and meta-analysis (identification number CRD42021227578) were performed to analyse the effects of PDE-5 inhibitors in patients with COPD. Data were sourced from MEDLINE, EMBASE, Cochrane Register of Controlled Trials and "ClinicalTrials.gov." Randomised controlled trials (RCTs) comparing PDE-5 inhibitors with control in patients with COPD were included. Quality assessment was carried out using the Cochrane Collaboration's tool for assessing the risk of bias in randomised trials. The pooled mean difference of 6-minute walk distance (6MWD) and mean pulmonary arterial pressure based on inverse variance estimation were analysed with a fixed-effect model or random-effects model meta-analysis. Nine RCTs involving 414 patients were included in the review. There was no significant difference in 6MWD (mean difference = 22.06 metres, 95% confidence interval (CI), -5.80 to 49.91). However, there was a statistically significant difference between PDE-5 inhibitor and control groups in mean pulmonary artery pressure (mean difference = -3.83 mmHg, 95% CI, -5.93 to -1.74). Headaches were the most common adverse event, occurring significantly in the PDE-5 inhibitor intervention group (odds ratio 3.83, 95% CI, 1.49 to 9.86). This systematic review indicates that PDE-5 inhibitors do not improve exercise capacity despite some possible improvements in haemodynamic parameters in COPD patients.
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Isa et al. (2022) conducted a meta-analysis in Chronic obstructive pulmonary disease (COPD) (n=414). PDE-5 inhibitors vs. control was evaluated on 6-minute walk distance (6MWD) (MD 22.06, 95% CI -5.80 to 49.91). PDE-5 inhibitors did not significantly improve 6-minute walk distance (MD 22.06 m; 95% CI -5.80 to 49.91) in COPD patients, despite a significant reduction in mean pulmonary artery pressure.
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