Key result
Inhaled iloprost monotherapy yields just ~13% 5-year event-free survival in idiopathic pulmonary arterial hypertension.
Why the study?
The long-term clinical efficacy of inhaled iloprost as first-line vasodilator mono-therapy in patients with idiopathic pulmonary arterial hypertension was not well described.
Does inhaled iloprost as first-line mono-therapy provide long-term clinical stabilization in patients with idiopathic pulmonary arterial hypertension?
Cohort (n=76)
Does inhaled iloprost as first-line mono-therapy provide long-term clinical stabilization in patients with idiopathic pulmonary arterial hypertension?
Inhaled iloprost mono-therapy has a limited role for long-term stabilization in patients with idiopathic pulmonary arterial hypertension, as most patients require additional or alternative therapies over time.
Inhaled iloprost monotherapy stabilizes few IPAH patients long-term; leaves open its niche amid modern combination regimens.
AIMS: To describe the long-term clinical efficacy of inhaled iloprost as first-line vasodilator mono-therapy in patients with idiopathic pulmonary arterial hypertension (IPAH). METHODS AND RESULTS: Seventy-six IPAH patients were prospectively identified and treated with inhaled iloprost. Clinical, haemodynamic, and exercise parameters were obtained at baseline, after 3 and 12 months of therapy and yearly thereafter. Four endpoints were prospectively defined as follows: (i) death, (ii) transplantation, (iii) switch to intravenous (i.v.) therapy, or (iv) addition of or switch to other active oral therapy. During follow-up (535+/-61 days), 11 patients died, six were transplanted, 25 were switched to i.v. prostanoids, 16 received additional or other oral therapy, and 12 patients discontinued iloprost inhalation for other reasons. Event-free survival at 3, 12, 24, 36, 48, and 60 months was 81, 53, 29, 20, 17 and 13%, respectively. Among haemodynamic and exercise parameters, mixed venous oxygen saturation (P<0.001), right atrial pressure (P<0.001), and peak oxygen uptake (P=0.002) were associated with event-free survival. CONCLUSION: In this study, only a minority of patients could be stabilized with inhaled iloprost mono-therapy during a follow-up period of up to 5 years. In the presence of multiple treatment options, chronic iloprost inhalation as mono-therapy appears to have a limited role.
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Opitz et al. (2005) conducted a cohort in idiopathic pulmonary arterial hypertension (n=76). inhaled iloprost was evaluated on death, transplantation, switch to intravenous (i.v.) therapy, or addition of or switch to other active oral therapy. Inhaled iloprost mono-therapy resulted in an event-free survival of 13% at 60 months, indicating a limited role for long-term stabilization in idiopathic pulmonary arterial hypertension.
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