Addition of sildenafil to bosentan monotherapy in pulmonary arterial hypertension
Addition of sildenafil to bosentan monotherapy in pulmonary arterial hypertension
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DOI：
10.1183/09031936.00081706
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发表时间：
2007-03-01
影响因子：
24.3
通讯作者：
Hassoun, P. M.
中科院分区：
文献类型：
--
作者：
Mathai, S. C.;Girgis, R. E.;Hassoun, P. M.
联合治疗已被推荐用于治疗肺动脉高压（PAH）。然而，关于单药治疗失败后联合治疗的信息很少，特别是在硬皮病相关PAH （PAH- ssd）患者中。从一组82例连续接受初始波生坦单药治疗的PAH患者中，共研究了13例特发性PAH （IPAH）和12例需要西地那非额外治疗的PAH- ssd患者。根据症状、纽约心脏协会（NYHA）分级或6分钟步行距离（6MWD），对临床恶化的患者加入西地那非。基线时收集临床资料和血流动力学。每隔1-3个月进行一次评估。在基线时，两组在人口统计学、NYHA分类、血流动力学或6MWD方面没有差异。在开始使用波生坦后，两组患者均经历了临床改善，但最终病情恶化（到单药治疗失败的中位时间为792天，而IPAH和PAH-SSD患者分别为458天）。在添加西地那非后，与PAH-SSD患者相比，更多的IPAH患者倾向于改善NYHA级（13人中有5人对12人中有2人），并且行走更远（6MWD的平均差异为47 +/- 77 m对-7 +/- 40 m）。波森坦单药治疗失败后加入西地那非改善特发性肺动脉高压患者的纽约心脏协会分级和6分钟步行距离，但未能改善硬皮病相关肺动脉高压患者的这两项参数。需要进一步的研究来评估这种联合治疗硬皮病相关性肺动脉高压患者的耐受性和疗效。
Combination therapy has been recommended for the treatment of pulmonary arterial hypertension (PAH). However, there is scant information on combination therapy after failure of monotherapy, particularly in patients with scleroderma-associated PAH (PAH-SSD).From a group of 82 consecutive patients with PAH who received initial bosentan monotherapy, a total of 13 idiopathic PAH (IPAH) and 12 PAH-SSD patients requiring additional therapy with sildenafil were studied. Sildenafil was added for clinical deterioration based upon symptoms, New York Heart Association (NYHA) classification or 6-min walk distance (6MWD). Clinical data and haemodynamics were collected at baseline. Assessments were made at 1-3-month intervals.At baseline, there were no differences in demographics, NYHA classification, haemodynamics or 6MWD between the two groups. After initiation of bosentan, both groups experienced clinical improvement but ultimately deteriorated (median time to monotherapy failure 792 versus 458 days for IPAH and PAH-SSD patients, respectively). After addition of sildenafil, more IPAH patients tended to improve in NYHA class (five out of 13 versus two out of 12) and walked further (mean difference in 6MWD 47 +/- 77 m versus -7 +/- 40 m) compared with PAH-SSD patientsIn conclusion, addition of sildenafil after bosentan monotherapy failure improved New York Heart Association class and 6-min walk distance in idiopathic pulmonary arterial hypertension patients but failed to improve either parameter in scleroderma-associated pulmonary arterial hypertension patients. Additional studies are needed to assess the tolerability and efficacy of this combination in patients with scleroderma-associated pulmonary arterial hypertension.