Aviptadil Therapy in Acute Respiratory Distress Syndrome Patients: A Systematic Review and Meta-analysis.

Summary

Across 9 studies (2 RCTs, 7 case series; n=665), aviptadil showed physiological benefits but no significant survival advantage versus placebo (OR 1.01, 95% CI 0.72–1.42). Evidence remains insufficient to support routine use in ARDS.

Key Findings

• Included 9 studies (2 RCTs, 7 case series) totaling 665 patients; 361 received aviptadil.
• Pooled survival odds ratio vs placebo was 1.01 (95% CI 0.72–1.42), indicating no survival benefit.
• Risk of bias assessed using RoB 2 for RCTs and JBI for case series; random-effects meta-analysis applied.
• Physiologic improvements in oxygenation were noted, but did not translate into survival gains.

Clinical Implications

Aviptadil should not be adopted routinely for ARDS outside clinical trials; focus should remain on evidence-based supportive care and enrollment in well-designed RCTs.

Limitations

• Only two RCTs available; remaining evidence from case series increases uncertainty
• Heterogeneity in dosing, timing, and endpoints; possible publication bias

Future Directions

Adequately powered, multi-center RCTs with standardized dosing/timing and ARDS phenotyping to test subgroup efficacy and patient-centered outcomes.