Inhaled iloprost in pulmonary arterial hypertension.
OBJECTIVE
To review the pharmacology, pharmacodynamics, and clinical trials evaluating inhaled iloprost in pulmonary arterial hypertension (PAH).


METHODS
A MEDLINE search (1996-February 2005) was performed using the key words pulmonary hypertension, iloprost, and epoprostenol. Information regarding Food and Drug Administration approval was obtained via the Internet.


METHODS
All clinical trials using inhaled iloprost in PAH published in English were identified. Additionally, references from the identified articles were reviewed.


RESULTS
A stable analog of prostacyclin, inhaled iloprost is thought to promote benefit in PAH through vasodilation, antiproliferative effects, and inhibition of platelet aggregation. In a placebo-controlled trial of 203 patients, inhaled iloprost significantly improved the combined endpoint of change in New York Heart Association functional class and 10% improvement in 6-minute walk distance (p = 0.007). Small, short-term clinical trials demonstrated hemodynamic benefits for inhaled iloprost alone and in combination with other pulmonary vasodilating agents. The aerosolized delivery route and low incidence of adverse events are positive attributes for inhaled iloprost, while the frequency of administration and lack of comparative data limit its role in PAH.


CONCLUSIONS
Currently, inhaled iloprost offers potential benefit for patients with contraindications to bosentan, preference for non-parenteral products, ineligibility for parenteral therapy, or as adjunctive therapy with other pulmonary vasodilators. Larger, long-term clinical trials are needed to solidify the role for inhaled iloprost in the management of PAH.
Department of Pharmacy Services, University of Virginia Health System, Charlottesville, VA 22908-0674, USA. seb9r@virginia.edu
Stacey E
SE
Baker
Rebecca Haynes
RH
Hockman
D000280:Administration, Inhalation; D000328:Adult; D002626:Chemistry, Pharmaceutical; D002648:Child; D002986:Clinical Trials as Topic; D003365:Costs and Cost Analysis; D004359:Drug Therapy, Combination; D011464:Epoprostenol / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D016285:Iloprost / Q000008:administration & dosage* / Q000009:adverse effects* / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use*; D016239:MEDLINE; D009569:Nitric Oxide / Q000008:administration & dosage / Q000627:therapeutic use; D014665:Vasodilator Agents / Q000008:administration & dosage* / Q000009:adverse effects* / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use*
D014665:Vasodilator Agents; D009569:Nitric Oxide; D011464:Epoprostenol; D016285:Iloprost