Effect of fasudil on clinical outcomes of pulmonary hypertension: a systematic review and meta-analysis

Pulmonary hypertension (PH) is a life-threatening condition with high mortality, categorized into Group 1-5 by distinct etiologies. Fasudil, a potent vasodilator targeting RhoA/Rho kinase pathway, holds promise for diverse PH pathologies. However, a systematic evaluation of its clinical benefits remains elusive. We conducted a systematic search in several databases. Meta-analysis using odds ratio and mean difference was performed, with an assessment of studies’ quality and pooled evidences. Inclusion of 3269 Group-3 PH patients demonstrated that Fasudil increased effective events, forced expiratory volume in one second (FEV₁), 6-minute walking distance (6MWD) and arterial partial pressure of oxygen (PaO₂), and decreased mean pulmonary artery pressure (mPAP) and pulmonary artery systolic pressure (PASP); Inclusion of 197 Group-2 PH patients suggested that Fasudil increased 6MWD and PaO₂, and decreased PASP. Subgroup analysis revealed no significant difference between 30 and 60 mg/day dosages of Fasudil, while administration durations and methods might affect its effectiveness in treating Group-3 PH patients. Our study favors the beneficial effects of Fasudil by enhancing FEV₁, 6MWD and PaO₂, and reducing mPAP and PASP on Group-3 PH patients, suggesting Fasudil as a viable treatment option and highlighting the need for further studies to inform healthcare policies. www.crd.york.ac.uk/prospero identifier is CRD42022308947