Key result
Switching from PDE-5 inhibitors to riociguat increased clinical improvement (41% vs 20%, OR 2.78) in patients with intermediate-risk pulmonary arterial hypertension.
Why the study?
Pulmonary hypertension is associated with endothelial dysfunction and decreased nitric oxide production, prompting a review of the mechanisms and evidence for switching from PDE-5 inhibitors to riociguat.
Does switching from PDE-5 inhibitors to riociguat optimize therapy in patients with pulmonary hypertension?
Does switching from PDE-5 inhibitors to riociguat optimize therapy in patients with pulmonary hypertension?
Switching from PDE-5 inhibitors to riociguat is a recognized and guideline-supported strategy for optimizing therapy in patients with pulmonary hypertension.
Riociguat may support switching from PDE-5 inhibitors in PH; extends options for patients with nitric oxide-independent therapy.
Pulmonary hypertension (PH) is a severe and often rapidly progressive disease with fatal outcome. Endothelial dysfunction in PH is associated with decreased nitric oxide production. After reviewing the mechanisms of action and the evidence base for specific therapy with phosphodiesterase 5 inhibitors (PDE-5) and soluble guanylate cyclase stimulators, a reseach review on switching from PDE-5 to riociguat is conducted. A potential advantage of riociguat is its independence from endogenous nitric oxide and from the other (besides PDE-5) isoenzymes of phosphodiesterases. The favorable efficacy profile of sildenafil has been proven for the main forms of pulmonary arterial hypertension, of riociguat for the main forms of pulmonary arterial hypertension and chronic thromboembolic PH. The clinical efficacy of replacing PDE-5 with riociguat has been demonstrated in uncontrolled trials and in the randomized controlled study REPLACE. The possibility of therapy optimization by switching from IFDE-5 to riociguat is fixed in the Russian (class and level of evidence B-3) and Eurasian (class and level of evidence IIb-B) clinical guidelines, as well as in the materials of the Cologne Expert Consensus. An additional argument for switching is the lower cost as compared to combination therapy in the Russian Federation. According to the Russian and Eurasian guidelines for PH and the Russian instructions for the use of riociguat, the drug should be taken at least 24 hours after sildenafil discontinuation.
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Martynyuk et al. (2021) conducted a review in Pulmonary arterial hypertension (n=226). Riociguat vs. Continued PDE-5 inhibitor therapy (sildenafil or tadalafil) was evaluated on Clinical improvement (achievement of ≥2 of 3 criteria: 6MWD increase ≥10%/≥30 m, WHO FC I/II, NT-proBNP decrease ≥30% without clinical worsening) (OR 2.78, 95% CI 1.53-5.06, p=0.0007). Switching from PDE-5 inhibitors to riociguat increased clinical improvement (41% vs 20%, OR 2.78) in patients with intermediate-risk pulmonary arterial hypertension.
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