Long‐term safety of macitentan in patients with pulmonary hypertension: A meta‐analysis of randomised controlled trials

Abstract Background Macitentan has demonstrated its effectiveness in patients with pulmonary hypertension (PH), but its safety, especially for long‐term use, needs to be further explored. This systematic review and meta‐analysis aimed to determine the safety of long‐term use of macitentan in patients with PH. Methods A systematic search was made of PubMed, Embase, Cochrane Library and clinicaltrials.gov , without language restrictions. Randomised controlled trials (RCTs) on treatment of PH with macitentan, compared with placebo, were reviewed. Estimated effects of included studies were pooled as risk ratios (RRs), with 95% confidence intervals (CIs). Results Six RCTs (enrolling 1003 participants) met the inclusion criteria. Anaemia (RR 3.86, 95% CI 2.05–7.30), headache (RR 1.52, 95% CI 1.02–2.26) and bronchitis (RR 2.24, 95% CI 1.30–3.87) were more frequent in the macitentan groups. There was no statistically significant difference in the proportion of patients with at least one adverse event (AE) or serious adverse event (SAE), AEs leading to discontinuation of study treatment, all‐cause death, right ventricular failure (RVF) and peripheral oedema between the two groups. Conclusions The long‐term use of macitentan is safe for patients with PH, although with a higher risk of anaemia, headache and bronchitis.