Beraprost sodium reduced disease progression at six months (P=0.002) compared with placebo, but this beneficial effect was not evident at shorter or longer follow-up intervals.
RCT (n=116)
Double-blind
randomized
Does beraprost sodium reduce disease progression in patients with WHO functional class II or III pulmonary arterial hypertension?
Oral beraprost sodium provides early improvements in disease progression and exercise capacity in PAH patients, but the benefits attenuate after 6 months of therapy.
p-value: p=0.002
OBJECTIVES: The purpose of this study was to assess the safety and efficacy of the oral prostacyclin analogue beraprost sodium during a 12-month double-blind, randomized, placebo-controlled trial in patients with pulmonary arterial hypertension (PAH). BACKGROUND: Pulmonary arterial hypertension is a progressive disease that ultimately causes right heart failure and death. Despite the risks from its delivery system, continuous intravenous epoprostenol remains the most efficacious treatment currently available. METHODS: A total of 116 patients with World Health Organization (WHO) functional class II or III primary pulmonary hypertension or PAH related to either collagen vascular diseases or congenital systemic to pulmonary shunts were enrolled. Patients were randomized to receive the maximal tolerated dose of beraprost sodium (median dose 120 microg four times a day) or placebo for 12 months. The primary end point was disease progression; i.e., death, transplantation, epoprostenol rescue, or >25% decrease in peak oxygen consumption (VO(2)). Secondary end points included exercise capacity assessed by 6-min walk test and peak VO(2), Borg dyspnea score, hemodynamics, symptoms of PAH, and quality of life. RESULTS: Patients treated with beraprost exhibited less evidence of disease progression at six months (p = 0.002), but this effect was not evident at either shorter or longer follow-up intervals. Similarly, beraprost-treated patients had improved 6-min walk distance at 3 months by 22 m from baseline and at 6 months by 31 m (p = 0.010 and 0.016, respectively) compared with placebo, but not at either 9 or 12 months. Drug-related adverse events were common and were related to the disease and/or expected prostacyclin adverse events. CONCLUSIONS: These data suggest that beneficial effects may occur during early phases of treatment with beraprost in WHO functional class II or III patients but that this effect attenuates with time.
Barst et al. (Sun,) conducted a rct in pulmonary arterial hypertension (n=116). Beraprost sodium vs. Placebo was evaluated on Disease progression (death, transplantation, epoprostenol rescue, or >25% decrease in peak oxygen consumption) (p=0.002). Beraprost sodium reduced disease progression at six months (P=0.002) compared with placebo, but this beneficial effect was not evident at shorter or longer follow-up intervals.
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