Back to Search
Start Over
Conversion to bosentan from prostacyclin infusion therapy in pulmonary arterial hypertension: a pilot study.
- Source :
-
Chest [Chest] 2006 Nov; Vol. 130 (5), pp. 1471-80. - Publication Year :
- 2006
-
Abstract
- Study Objectives: We assessed the efficacy of bosentan in transitioning from prostacyclin infusions in patients with pulmonary arterial hypertension (PAH).<br />Methods: Twenty-two PAH patients were recruited from five PAH centers if they had been clinically stable while receiving therapy with IV epoprostenol or subcutaneous treprostinil for at least 3 months. Patients were observed in an open-label prospective trial while bosentan was added to therapy, and then epoprostenol or treprostinil were tapered after 2 months.<br />Results: Ten of the 22 patients were transitioned off prostacyclin infusion therapy after a mean (+/- SEM) duration of 6.1 +/- 1.2 months. Of those patients, seven patients have continued not receiving prostacyclin infusion therapy for a mean duration of 17.7 +/- 5.3 months, with no significant changes in pulmonary artery (PA) pressure estimated by echocardiography, World Health Organization (WHO)/New York Heart Association (NYHA) functional class, 6-min walk distance (6MWD), or Borg dyspnea score. The conditions of three patients deteriorated, necessitating the resumption of prostacyclin therapy, and two patients subsequently died. Twelve patients failed to transition or even lower the prostacylin infusion rate and had worsening of their WHO/NYHA functional class and estimated systolic PA pressures, and had a trend toward deterioration in their mean 6MWD (294 +/- 41 to 198 +/- 34 m, respectively; p = 0.2). Of these, two patients subsequently died. The baseline characteristics of those who transitioned successfully vs those who transitioned unsuccessfully were a lower prostacyclin infusion rate, and less severe elevations in the mean and estimated systolic PA pressures.<br />Conclusion: Transitioning from therapy with prostacyclin to bosentan is possible in some PAH patients, mainly in those receiving lower prostacyclin doses and having less pulmonary hypertension at baseline. Careful patient selection and close interim monitoring is needed because the conditions of patients can deteriorate, and they may not respond to the resumption of therapy with prostacyclin.
- Subjects :
- Administration, Oral
Adult
Aged
Antihypertensive Agents adverse effects
Blood Pressure drug effects
Blood Pressure physiology
Bosentan
Dose-Response Relationship, Drug
Epoprostenol adverse effects
Epoprostenol pharmacology
Female
Humans
Hypertension, Pulmonary physiopathology
Infusions, Intravenous
Lung blood supply
Lung drug effects
Lung physiopathology
Middle Aged
Physical Endurance drug effects
Physical Endurance physiology
Pilot Projects
Severity of Illness Index
Sulfonamides adverse effects
Walking physiology
Antihypertensive Agents therapeutic use
Epoprostenol analogs & derivatives
Epoprostenol therapeutic use
Hypertension, Pulmonary drug therapy
Sulfonamides therapeutic use
Subjects
Details
- Language :
- English
- ISSN :
- 0012-3692
- Volume :
- 130
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- Chest
- Publication Type :
- Academic Journal
- Accession number :
- 17099026
- Full Text :
- https://doi.org/10.1378/chest.130.5.1471