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Conversion to bosentan from prostacyclin infusion therapy in pulmonary arterial hypertension: a pilot study.
Chest. 2006 Nov; 130(5):1471-80.Chest

Abstract

STUDY OBJECTIVES

We assessed the efficacy of bosentan in transitioning from prostacyclin infusions in patients with pulmonary arterial hypertension (PAH).

METHODS

Twenty-two PAH patients were recruited from five PAH centers if they had been clinically stable while receiving therapy with IV epoprostenol or subcutaneous treprostinil for at least 3 months. Patients were observed in an open-label prospective trial while bosentan was added to therapy, and then epoprostenol or treprostinil were tapered after 2 months.

RESULTS

Ten of the 22 patients were transitioned off prostacyclin infusion therapy after a mean (+/- SEM) duration of 6.1 +/- 1.2 months. Of those patients, seven patients have continued not receiving prostacyclin infusion therapy for a mean duration of 17.7 +/- 5.3 months, with no significant changes in pulmonary artery (PA) pressure estimated by echocardiography, World Health Organization (WHO)/New York Heart Association (NYHA) functional class, 6-min walk distance (6MWD), or Borg dyspnea score. The conditions of three patients deteriorated, necessitating the resumption of prostacyclin therapy, and two patients subsequently died. Twelve patients failed to transition or even lower the prostacylin infusion rate and had worsening of their WHO/NYHA functional class and estimated systolic PA pressures, and had a trend toward deterioration in their mean 6MWD (294 +/- 41 to 198 +/- 34 m, respectively; p = 0.2). Of these, two patients subsequently died. The baseline characteristics of those who transitioned successfully vs those who transitioned unsuccessfully were a lower prostacyclin infusion rate, and less severe elevations in the mean and estimated systolic PA pressures.

CONCLUSION

Transitioning from therapy with prostacyclin to bosentan is possible in some PAH patients, mainly in those receiving lower prostacyclin doses and having less pulmonary hypertension at baseline. Careful patient selection and close interim monitoring is needed because the conditions of patients can deteriorate, and they may not respond to the resumption of therapy with prostacyclin.

Authors+Show Affiliations

Tufts-New England Medical Center, Boston, MA, USA. ksteiner@partners.orgNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17099026

Citation

Steiner, M Kathryn, et al. "Conversion to Bosentan From Prostacyclin Infusion Therapy in Pulmonary Arterial Hypertension: a Pilot Study." Chest, vol. 130, no. 5, 2006, pp. 1471-80.
Steiner MK, Preston IR, Klinger JR, et al. Conversion to bosentan from prostacyclin infusion therapy in pulmonary arterial hypertension: a pilot study. Chest. 2006;130(5):1471-80.
Steiner, M. K., Preston, I. R., Klinger, J. R., Criner, G. J., Waxman, A. B., Farber, H. W., & Hill, N. S. (2006). Conversion to bosentan from prostacyclin infusion therapy in pulmonary arterial hypertension: a pilot study. Chest, 130(5), 1471-80.
Steiner MK, et al. Conversion to Bosentan From Prostacyclin Infusion Therapy in Pulmonary Arterial Hypertension: a Pilot Study. Chest. 2006;130(5):1471-80. PubMed PMID: 17099026.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Conversion to bosentan from prostacyclin infusion therapy in pulmonary arterial hypertension: a pilot study. AU - Steiner,M Kathryn, AU - Preston,Ioana R, AU - Klinger,James R, AU - Criner,Gerard J, AU - Waxman,Aaron B, AU - Farber,Harrison W, AU - Hill,Nicholas S, PY - 2006/11/14/pubmed PY - 2006/12/15/medline PY - 2006/11/14/entrez SP - 1471 EP - 80 JF - Chest JO - Chest VL - 130 IS - 5 N2 - STUDY OBJECTIVES: We assessed the efficacy of bosentan in transitioning from prostacyclin infusions in patients with pulmonary arterial hypertension (PAH). METHODS: Twenty-two PAH patients were recruited from five PAH centers if they had been clinically stable while receiving therapy with IV epoprostenol or subcutaneous treprostinil for at least 3 months. Patients were observed in an open-label prospective trial while bosentan was added to therapy, and then epoprostenol or treprostinil were tapered after 2 months. RESULTS: Ten of the 22 patients were transitioned off prostacyclin infusion therapy after a mean (+/- SEM) duration of 6.1 +/- 1.2 months. Of those patients, seven patients have continued not receiving prostacyclin infusion therapy for a mean duration of 17.7 +/- 5.3 months, with no significant changes in pulmonary artery (PA) pressure estimated by echocardiography, World Health Organization (WHO)/New York Heart Association (NYHA) functional class, 6-min walk distance (6MWD), or Borg dyspnea score. The conditions of three patients deteriorated, necessitating the resumption of prostacyclin therapy, and two patients subsequently died. Twelve patients failed to transition or even lower the prostacylin infusion rate and had worsening of their WHO/NYHA functional class and estimated systolic PA pressures, and had a trend toward deterioration in their mean 6MWD (294 +/- 41 to 198 +/- 34 m, respectively; p = 0.2). Of these, two patients subsequently died. The baseline characteristics of those who transitioned successfully vs those who transitioned unsuccessfully were a lower prostacyclin infusion rate, and less severe elevations in the mean and estimated systolic PA pressures. CONCLUSION: Transitioning from therapy with prostacyclin to bosentan is possible in some PAH patients, mainly in those receiving lower prostacyclin doses and having less pulmonary hypertension at baseline. Careful patient selection and close interim monitoring is needed because the conditions of patients can deteriorate, and they may not respond to the resumption of therapy with prostacyclin. SN - 0012-3692 UR - https://www.unboundmedicine.com/medline/citation/17099026/Conversion_to_bosentan_from_prostacyclin_infusion_therapy_in_pulmonary_arterial_hypertension:_a_pilot_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0012-3692(15)37325-6 DB - PRIME DP - Unbound Medicine ER -