Key result
The addition of bosentan to high-dose epoprostenol in patients with idiopathic pulmonary arterial hypertension significantly reduced systolic pulmonary artery pressure from 80.1 to 66.8 mmHg (p<0.05).
Why the study?
Does the addition of bosentan improve hemodynamics and allow for dose reduction in patients with idiopathic pulmonary arterial hypertension already stabilized on high-dose epoprostenol?
Does the addition of bosentan improve hemodynamics and allow for dose reduction in patients with idiopathic pulmonary arterial hypertension already stabilized on high-dose epoprostenol?
Absolute Event Rate: 66.8% vs 80.1%
p-value: p=<0.05
The addition of bosentan to high-dose epoprostenol in stabilized IPAH patients safely improves hemodynamics and facilitates a reduction in epoprostenol dosage.
May support bosentan add-on in select IPAH cases; hypothesis-generating and should not yet change practice.
BACKGROUND: Combination therapy has been proposed in treatment algorithms for idiopathic pulmonary arterial hypertension (IPAH), so the additional effects of bosentan in IPAH patients already treated with high-dose epoprostenol (EPO) was evaluated in the present study. METHODS AND RESULTS: Bosentan (62.5 mg twice daily) was administered to 8 IPAH patients already being treated with high-dose EPO (average dose 99.6+/-43.4 ng . kg(-1) . min(-1)). Hemodynamics were assessed at baseline and at 2 days and then 1 year after the initiation of bosentan. Because a remarkable elevation of mixed venous oxygen saturation was observed at the initiation of bosentan, the dosage of EPO was reduced in 7 patients (from 99.6+/-43.4 to 82.8+/-31.3 ng . kg(-1) . min(-1), p<0.05). There was a significant decrease from the baseline value for systolic pulmonary artery pressure (80.1+/-19.3 to 66.8+/-16.5 mmHg, p<0.05). These effects were maintained for 1 year without progression of PAH in 6 patients whose condition had been stabilized at baseline. CONCLUSIONS: The additional use of bosentan for IPAH patients whose condition has been stabilized by high-dose EPO is safe and effective.
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Akagi et al. (2008) studied Idiopathic pulmonary arterial hypertension (IPAH) (n=8). Bosentan vs. Baseline (pre-intervention) was evaluated on Systolic pulmonary artery pressure (sPAP) (p=<0.05). The addition of bosentan to high-dose epoprostenol in patients with idiopathic pulmonary arterial hypertension significantly reduced systolic pulmonary artery pressure from 80.1 to 66.8 mmHg (p<0.05).
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