Goal-oriented treatment and combination therapy for pulmonary arterial hypertension
Goal-oriented treatment and combination therapy for pulmonary arterial hypertension
复制标题
DOI：
10.1183/09031936.05.00075305
复制
发表时间：
2005-11-01
影响因子：
24.3
通讯作者：
Niedermeyer, J
中科院分区：
文献类型：
--
作者：
Hoeper, MM;Markevych, I;Niedermeyer, J
联合治疗可改善重度肺动脉高压（PAH）患者的结局。PAH患者根据目标导向的治疗策略进行治疗。单药治疗未达到治疗目标的患者根据预先确定的策略接受联合治疗，包括波生坦、西地那非和吸入性伊洛前列素。静脉注射伊洛前列素和肺移植用于治疗失败。终点为总生存率、无移植生存率、无移植和静脉注射前列腺素治疗的生存率。在2002年1月至2004年12月期间，123例PAH患者接受了新方法的治疗。1年、2年和3年的生存率分别为93.0%、83.1%和79.9%，显著优于历史对照组的生存率以及预期生存率。与历史对照组相比，使用联合治疗也显著改善了死亡、肺移植和需要静脉伊洛前列素治疗的联合终点。总之，使用波生坦、西地那非和吸入伊洛前列素联合目标导向治疗策略的治疗方法在重度肺动脉高压患者中提供了可接受的长期结果，并且减少了对静脉内前列腺素治疗和肺移植的需要。
Combination therapy may improve outcome in patients with severe pulmonary arterial hypertension (PAH).PAH patients were treated according to a goal-oriented therapeutic strategy. Patients who did not reach the treatment goals with monotherapy received combination treatment according to a predefined strategy, including bosentan, sildenafil and inhaled iloprost. Intravenous iloprost and lung transplantation were reserved for treatment failures. End points were overall survival, transplantation-free survival, and survival free from transplantation and intravenous prostanoid treatment.Between January 2002 and December 2004, 123 consecutive patients with PAH were treated according to the novel approach. Survival at 1, 2 and 3 yrs was 93.0, 83.1 and 79.9%, respectively, which was significantly better than the survival of a historical control group, as well as the expected survival. Compared to the historical control group, the use of combination treatment also significantly improved the combined end point of death, lung transplantation and need for intravenous iloprost treatment.In conclusion, a therapeutic approach utilising combinations of bosentan, sildenafil and inhaled iloprost in conjunction with a goal-oriented treatment strategy provides acceptable long-term results in patients with severe pulmonary arterial hypertension, and reduces the need for intravenous prostaglandin treatment and lung transplantation.