Should oral combination therapy be the standard of care for pulmonary arterial hypertension?
Should oral combination therapy be the standard of care for pulmonary arterial hypertension?
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口服联合治疗是否应该成为肺动脉高压的标准治疗方法？
DOI：
10.1080/17476348.2020.1722641
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发表时间：
2020
期刊：
影响因子：
--
通讯作者：
Matsubara H.
中科院分区：
文献类型：
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作者：
Ogawa A;Matsubara H.
肺动脉高压（PAH）是一种进行性疾病，肺血管阻力和肺动脉压增加。过去二十年来，PAH药物开发研究的进展使患者有机会获得各种PAH药物，这些药物可改变三种途径：前列环素类似物（PCA）/前列环素受体激动剂、内皮素受体拮抗剂和磷酸二酯酶-5抑制剂/可溶性鸟苷酸环化酶刺激剂[1]。最近，据报道，使用两种或三种PAH药物的初始/前期联合治疗可改善运动能力和血流动力学[2 - 4]。然而，一项研究仅使用口服联合治疗[4]，并纳入了低/中风险患者。尽管其他研究包括使用最强效的药物（胃肠外PCA）进行治疗[2，3]，但患者接受了低剂量（约20 ng/kg/min）PCA治疗。
Pulmonary arterial hypertension (PAH) is a progressive disease with increased pulmonary vascular resistance and pulmonary arterial pressure. Progress in research to develop PAH drugs over the past two decades has given patients opportunities to access various PAH drugs which modify three pathways: prostacyclin analogue (PCA)/prostacyclin-receptor agonist, endothelinreceptor antagonist, and phosphodiesterase-5 inhibitor/soluble guanylate cyclase stimulator [1]. Recently, it has been reported that initial/upfront combination therapy using two or three PAH drugs improves exercise capacity and hemodynamics [2-4]. However, one study only used oral combination therapy [4] and included patients with low-/intermediate-risk. Although other studies included treatment with the most potent drug, parenteral PCA [2, 3], patients were treated with low-dose (~ 20 ng/kg/min) of PCA.