Sildenafil therapy in patients with sickle cell disease and pulmonary hypertension.
Pulmonary hypertension is a frequent complication of sickle cell disease that is associated with haemolysis, impaired nitric oxide bioavailability and high mortality. We sought to evaluate the safety and efficacy of selective pulmonary vasodilators and antiproliferative agents in this at-risk population. After optimising sickle cell disease therapy to stabilise haemoglobin and fetal haemoglobin levels, we evaluated the safety and efficacy of sildenafil in 12 patients with sickle cell disease and pulmonary hypertension. Sildenafil therapy (mean duration 6 +/- 1 months) decreased the estimated pulmonary artery systolic pressure [50 +/- 4 to 41 +/- 3 mmHg; difference 9 mmHg, 95% confidence interval (CI): 0.3-17, P = 0.043] and increased the 6-min walk distance (384 +/- 30 to 462 +/- 28 m; difference 78 m, 95% CI: 40-117, P = 0.0012). Transient headaches occurred in two patients and transient eye-lid oedema in four patients. No episodes of priapism occurred in the three men in the study; two of them were on chronic exchange transfusions and one had erectile dysfunction.


CONCLUSIONS
(1) sickle cell disease patients with anaemia and pulmonary hypertension have significant exercise limitation; (2) the 6-min walk distance may be a valid endpoint in this population; (3) therapy with sildenafil appears safe and improves pulmonary hypertension and exercise capacity. Additional phase I studies in males with sickle cell disease followed by phase II/III placebo controlled trials evaluating the safety and efficacy of sildenafil therapy in sickle cell disease patients with pulmonary hypertension are warranted.
Machado
Roberto F
RF
Vascular Therapeutics Section, Cardiovascular Branch, National Heart Lung and Blood Institute, Bethesda, MD, USA. robertom@nhlbi.nih.gov
Martyr
Sabrina
S
Kato
Gregory J
GJ
Barst
Robyn J
RJ
Anthi
Anastasia
A
Robinson
Michael R
MR
Hunter
Lori
L
Coles
Wynona
W
Nichols
James
J
Hunter
Christian
C
Sachdev
Vandana
V
Castro
Oswaldo
O
Gladwin
Mark T
MT
D000328:Adult; D000755:Anemia, Sickle Cell / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D006328:Cardiac Catheterization; D004452:Echocardiography; D005080:Exercise Test; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D010879:Piperazines / Q000627:therapeutic use*; D011687:Purines; D015203:Reproducibility of Results; D000068677:Sildenafil Citrate; D018709:Statistics, Nonparametric; D013450:Sulfones; D013599:Systole; D014655:Vascular Resistance / Q000187:drug effects; D014665:Vasodilator Agents / Q000627:therapeutic use*
D010879:Piperazines; D011687:Purines; D013450:Sulfones; D014665:Vasodilator Agents; D000068677:Sildenafil Citrate