Angiotensin receptor blockers and β blockers in Marfan syndrome: an individual patient data meta-analysis of randomised trials

作者：Alex Pitcher, Enti Spata, Jonathan Emberson, Kelly Davies, Heather J. Halls, Lisa Holland, Kate F. Wilson, Christina A. Reith, Anne H. Child, Tim C. Clayton, Matthew Dodd, Marcus D Flather, Xu Yu Jin, George G.S. Sandor, Maarten Groenink, Barbara J.M. Mulder, Julie F A De Backer, Arturo Evangelista, Alberto Forteza, Gisela Teixidó‐Turà, Cathérine Boileau, Guillaume Jondeau, Olivier Milleron, Ronald V. Lacro, Lynn A. Sleeper, Hsin–Hui Chiu, Mei‐Hwan Wu, Stefan Neubauer, Hugh C Watkins, Hal Dietz, Colin Baigent · 发表于：The Lancet · 年份：2022 · DOI：10.1016/s0140-6736(22)01534-3 · 被引用次数：123 · 研究领域：Connective tissue disorders research、Aortic Disease and Treatment Approaches、Aortic aneurysm repair treatments

BACKGROUND: Angiotensin receptor blockers (ARBs) and β blockers are widely used in the treatment of Marfan syndrome to try to reduce the rate of progressive aortic root enlargement characteristic of this condition, but their separate and joint effects are uncertain. We aimed to determine these effects in a collaborative individual patient data meta-analysis of randomised trials of these treatments. METHODS: In this meta-analysis, we identified relevant trials of patients with Marfan syndrome by systematically searching MEDLINE, Embase, and CENTRAL from database inception to Nov 2, 2021. Trials were eligible if they involved a randomised comparison of an ARB versus control or an ARB versus β blocker. We used individual patient data from patients with no prior aortic surgery to estimate the effects of: ARB versus control (placebo or open control); ARB versus β blocker; and indirectly, β blocker versus control. The primary endpoint was the annual rate of change of body surface area-adjusted aortic root dimension Z score, measured at the sinuses of Valsalva. FINDINGS: We identified ten potentially eligible trials including 1836 patients from our search, from which seven trials and 1442 patients were eligible for inclusion in our main analyses. Four trials involving 676 eligible participants compared ARB with control. During a median follow-up of 3 years, allocation to ARB approximately halved the annual rate of change in the aortic root Z score (mean annual increase 0·07 [SE 0·02...