Research News: Angiotensin receptor blockers and β blockers in Marfan syndrome

A new publication titled Angiotensin receptor blockers and β blockers in Marfan syndrome: an individual patient data meta-analysis of randomised trials has been published in The Lancet Journal and is co-authored by several members of our Heritable Thoracic Aortic Diseases Working Group (HTAD WG), Prof. Maarten Groenink, Prof. Julie De Backer, Prof. Arturo Evangelista, Prof Guillaume Jondeau, Dr. Gisela Teixido-Turà, and Dr. Olivier Milleron.

The Marfan Treatment Trialists’ [MTT] Collaboration is a group established in 2012 to conduct a meta-analysis of individual patient data from all relevant Marfan syndrome trials. These clinical trials were conducted as a result of a hypothesis that angiotensin receptor blockade (which attenuates TGFβ activity) might slow aortic root growth in Marfan syndrome. Most of the participating trial groups in the MTT Collaboration have successfully published their findings including several meta-analyses of published data that concluded that angiotensin receptor blockers (ARBs) are effective when used alone or when added to a β blocker. However, these meta-analyses could be subject to biases as it includes only published data.

In this paper, the authors describe a meta-analysis in which the availability of individual patient data removes these biases, allowing a more complete assessment of ARBs in Marfan syndrome. The results show that

“in people with Marfan syndrome and no previous aortic surgery, ARBs reduced the rate of increase of the aortic root Z score by about one half, including among those taking a β blocker. The effects of β blockers were similar to those of ARBs. Assuming additivity, combination therapy with both ARBs and β blockers from the time of diagnosis would provide even greater reductions in the rate of aortic enlargement than either treatment alone, which, if maintained over a number of years, would be expected to lead to a delay in the need for aortic surgery.”

The results of this study suggest that lowering the rate of aortic root enlargement with a combination of ARBs and β blockers over a sustained period may delay the necessity for surgery in Marfan syndrome.

Access the article here

Reference: Pitcher A, Spata E, Emberson J, Davies K, Halls H, Holland L, Wilson K, Reith C, Child A.H, Clayton T, Dodd M, Flather M, Jin X.Y, Sandor G, Groenink M, Mulder B, De Backer J, Evangelista A, Forteza A, Teixido-Turà G, Boileau C, Jondeau G, Milleron O, Lacro R.V, Sleeper LA, Chiu H.H, Wu M.H, Neubauer S, Watkins H, Dietz H, Baigent C. Angiotensin receptor blockers and β blockers in Marfan syndrome: an individual patient data meta-analysis of randomised trials. The Lancet (2022).

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