Long-term treatment, tolerability, and survival with sub-cutaneous treprostinil for severe pulmonary hypertension
Long-term treatment, tolerability, and survival with sub-cutaneous treprostinil for severe pulmonary hypertension
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DOI：
10.1016/j.healun.2012.02.025
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发表时间：
2012-07-01
影响因子：
8.9
通讯作者：
Lang, Irene M.
中科院分区：
文献类型：
--
作者：
Sadushi-Kolici, Roela;Skoro-Sajer, Nika;Lang, Irene M.
随机对照试验改善了肺动脉高压的结局;然而，由于严格的入选标准、预先规定的患者子集和研究持续时间，这些试验存在偏倚。此外，通常的做法是在更有效和可滴定的前列腺素类治疗之前开始口服治疗，尽管诊断时疾病状态较严重。我们的前瞻性登记研究的目的是评估对功能分级、6分钟步行距离、血流动力学和生存率的长期影响，以及严重肺动脉高压患者一线皮下注射曲前列尼尔（一种前列环素类似物）的长期耐受性。平均右动脉压>= 10 mmHg和/或心脏指数6个月，9年生存率为57%.CONCLUSION：曲前列环素皮下注射一线治疗重度毛细血管前肺动脉高压多年来安全有效。如果可以耐受超过6个月的剂量上调，则达到有效剂量，结局良好。J Heart Lung Transplant 2012;31：735-43（C）2012国际心肺移植学会。All rights reserved.
Randomized controlled trials have resulted in improved outcomes in pulmonary arterial hypertension; however, they are biased by stringent inclusion criteria, pre-specified patient sub-sets, and study durations. In addition, common practice is to start oral therapies ahead of the more potent and titratable prostanoid therapies, despite advanced disease states at diagnosis. The objectives of our prospective registry were to evaluate long-term effects on functional class, 6-minute walking distance, hemodynamics, and survival, and also long-term tolerability of first-line sub-cutaneous treprostinil, a prostacyclin analog, in patients with severe pulmonary hypertension.METHODS: Data were collected from patients with functional class III/IV pre-capillary pulmonary hypertension (Dana Point groups 1 and 4; mean right arterial pressure >= 10 mmHg, and/or cardiac index 6 months, survival rates were 57% at 9 years.CONCLUSION: First-line treatment of severe pre-capillary pulmonary hypertension with sub-cutaneous treprostinil is safe and efficacious over many years. If up-titration beyond 6 months is tolerated, effective doses are reached and outcomes are good. J Heart Lung Transplant 2012;31:735-43 (C) 2012 International Society for Heart and Lung Transplantation. All rights reserved.