Epoprostenol for treatment of pulmonary hypertension in patients with systemic lupus erythematosus.
OBJECTIVE
Pulmonary hypertension with pathological changes similar to those observed in primary pulmonary hypertension occurs in patients with systemic lupus erythematosus (SLE). The efficacy of chronic epoprostenol therapy in SLE has not been well described. The objective of this paper is to describe our experience with long-term epoprostenol therapy in patients with pulmonary hypertension associated with SLE.


METHODS
Case series of six patients with SLE and associated pulmonary hypertension receiving chronic treatment with epoprostenol.


RESULTS
All 6 patients had severe pulmonary hypertension. Mean pulmonary artery pressure (mPAP) was 57 +/- 9 mm Hg (mean +/- SD), and pulmonary vascular resistance was 14 +/- 7 units before beginning therapy with epoprostenol. In 4 patients who underwent repeat hemodynamic evaluation (9 to 16 months after starting epoprostenol), mean pulmonary artery pressure decreased by 38 +/- 21% and pulmonary vascular resistance by 58 +/- 12%. Clinically, all patients improved from New York Heart Association class III or IV to class I or II. Doses of epoprostenol ranged from 4 to 46 ng/kg/min, and the longest duration of therapy has been 2.5 years. Side effects from epoprostenol have not differed from those seen in patients with primary pulmonary hypertension, and except for one patient, there has been no exacerbation of SLE.


CONCLUSIONS
Epoprostenol was effective for the treatment of pulmonary hypertension in this small group of patients with SLE. Further evaluation of epoprostenol therapy for patients with SLE and other diseases associated with pulmonary hypertension is warranted.
Robbins
I M
IM
Center for Lung Research, Department of Medicine (Drs. Robbins and Loyd), Vanderbilt University School of Medicine, Nashville, TN 37232, USA. Ivan.Robbins@mcmail.vanderbilt.edu
Gaine
S P
SP
Schilz
R
R
Tapson
V F
VF
Rubin
L J
LJ
Loyd
J E
JE
D000328:Adult; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D006328:Cardiac Catheterization; D016022:Case-Control Studies; D011464:Epoprostenol / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D008180:Lupus Erythematosus, Systemic / Q000150:complications*; D011669:Pulmonary Wedge Pressure / Q000187:drug effects; D016896:Treatment Outcome; D014655:Vascular Resistance / Q000187:drug effects; D014664:Vasodilation / Q000187:drug effects
D000959:Antihypertensive Agents; D011464:Epoprostenol