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Riociguat for patients with chronic thromboembolic pulmonary hypertension: Usefulness of transitioning from phosphodiesterase type 5 inhibitor.
- Source :
-
Respiratory investigation [Respir Investig] 2017 Jul; Vol. 55 (4), pp. 270-275. Date of Electronic Publication: 2017 Jun 19. - Publication Year :
- 2017
-
Abstract
- Background: Riociguat, the first approved drug for patients with chronic thromboembolic pulmonary hypertension (CTEPH), is a soluble guanylate cyclase (sGC) Stimulator. It directly stimulates sGC independently of nitric oxide (NO) and increases sGC sensitivity for NO. The safety and efficacy of transitioning from a phosphodiesterase 5 inhibitor (PDE5i) to riociguat is unknown.<br />Methods and Results: Twenty-three patients were prospectively enrolled: 8 symptomatic patients with inadequate clinical responses to PDE5i were changed to riociguat (transitioned group); 15 started riociguat anew (new or add-on group). We analyzed the change from baseline to 6-12 months of riociguat treatment for the 6-minute walk distance (6MWD), mean pulmonary arterial pressure (mPAP), pulmonary vascular resistance (PVR), cardiac index (CI), partial pressure of oxygen in arterial blood (PaO2), brain natriuretic peptide (BNP), World Health Organization (WHO) functional class, safety and adverse events. The mPAP, BNP and WHO functional class significantly improved in total. In the transitioned group, BNP significantly decreased by -116.5±188.6pg/ml (P=0.0156). The 6MWD, mPAP, PVR, CI, and PaO2 improved but not significantly. The baseline condition was significantly more severe in the transitioned than in the new or add-on group. No patients discontinued riociguat. Relatively rapid transitioning from PDE5i to riociguat was safe under careful observation.<br />Conclusions: Transitioning to riociguat may be safe and effective in CTEPH patients with inadequate clinical responses to PDE5i.<br /> (Copyright © 2017 The Japanese Respiratory Society. Published by Elsevier B.V. All rights reserved.)
- Subjects :
- Aged
Arterial Pressure
Chronic Disease
Female
Humans
Hypertension, Pulmonary metabolism
Hypertension, Pulmonary physiopathology
Male
Middle Aged
Natriuretic Peptide, Brain metabolism
Oxygen Consumption
Partial Pressure
Pulmonary Artery physiopathology
Pulmonary Embolism metabolism
Pulmonary Embolism physiopathology
Time Factors
Vascular Resistance
Walk Test
Drug Substitution
Hypertension, Pulmonary drug therapy
Phosphodiesterase 5 Inhibitors therapeutic use
Pulmonary Embolism drug therapy
Pyrazoles therapeutic use
Pyrimidines therapeutic use
Subjects
Details
- Language :
- English
- ISSN :
- 2212-5353
- Volume :
- 55
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Respiratory investigation
- Publication Type :
- Academic Journal
- Accession number :
- 28705306
- Full Text :
- https://doi.org/10.1016/j.resinv.2017.04.004