Survival with sildenafil and inhaled iloprost in a cohort with pulmonary hypertension: an observational studyReport as inadecuate




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BMC Pulmonary Medicine

, 16:5

Infectious, Rare and Idiopathic Pulmonary Diseases

Abstract

BackgroundCombination therapy is frequently used to treat patients with pulmonary hypertension but few studies have compared treatment regimens. This study examined the long-term effect of different combination regimens of inhaled iloprost and oral sildenafil on survival and disease progression.

MethodsThis was a retrospective study of patients in the Giessen Pulmonary Hypertension Registry who received iloprost monotherapy followed by addition of sildenafil iloprost-sildenafil, sildenafil monotherapy followed by addition of iloprost sildenafil-iloprost, or upfront combination therapy iloprost + sildenafil. The primary outcome was transplant-free survival Kaplan–Meier analysis. When available, haemodynamic parameters and 6-minute-walk distance were evaluated.

ResultsOverall, 148 patients were included. Baseline characteristics were similar across treatment groups; however, the iloprost + sildenafil cohort had higher mean pulmonary vascular resistance and pulmonary arterial pressure than the others. Transplant-free survival differed significantly between groups P = 0.007, log-rank test. Cumulative transplant-free survival was highest for patients who received iloprost-sildenafil 1 year survival: iloprost-sildenafil, 95.1 %; sildenafil-iloprost, 91.8 %; iloprost + sildenafil, 62.9 %; this group also remained on monotherapy significantly longer than the sildenafil-iloprost group median 17.0 months vs 7.0 months, respectively; P = 0.004. Compared with pre-treatment values, mean 6-minute-walk distance increased significantly for all groups 3 months after beginning combination therapy.

ConclusionsIn this observational study of patients with pulmonary hypertension receiving combination therapy with iloprost and sildenafil, cumulative transplant-free survival was highest in those who received iloprost monotherapy initially. However, owing to the size and retrospective design of this study, further research is needed before making firm treatment recommendations.

KeywordsCombination therapy Iloprost Sildenafil Pulmonary hypertension Giessen pulmonary hypertension registry AbbreviationscAMPCyclic adenosine monophosphate

cGMPCyclic guanosine monophosphate

6MWD6-minute-walk distance

NYHANew York Heart Association

PAHPulmonary arterial hypertension

PAPPulmonary arterial pressure

PDE-5Phosphodiesterase type 5

PHPulmonary hypertension

PVRPulmonary vascular resistance

Electronic supplementary materialThe online version of this article doi:10.1186-s12890-015-0164-2 contains supplementary material, which is available to authorized users.

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Author: Henning Gall - Natascha Sommer - Katrin Milger - Manuel J. Richter - Robert Voswinckel - Dirk Bandorski - Werner Seeger -

Source: https://link.springer.com/article/10.1186/s12890-015-0164-2







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