Successful switch from long-term intravenous iloprost to non-invasive combination therapy in idiopathic pulmonary arterial hypertension.
In Europe intravenous (IV) iloprost, an alternative to epoprostenol, is an accepted treatment option for severely compromised patients with idiopathic pulmonary arterial hypertension (IPAH). Once initiated, this therapy usually has to be continued lifelong or as bridging to transplantation. In our paper we describe two patients with IPAH in World Health Organisation (WHO) functional classes II and III while on treatment with continuous IV iloprost monotherapy or combination therapy with continuous IV iloprost plus oral bosentan, respectively. The duration of IV iloprost therapy was 4.5 and 2.5 years, respectively. Because of life-threatening or recurring catheter-related complications during long-term IV iloprost therapy, these patients were switched to non-invasive combination therapy consisting of oral bosentan plus aerosolized iloprost (patient 1) and oral bosentan plus aerosolized iloprost plus oral sildenafil (patient 2), respectively. After four weeks of additional bosentan therapy, stepwise reduction and discontinuation of IV iloprost were performed within eight hours in the patient in WHO class II, and within five days in the patient in WHO class III. Simultaneously, therapy with aerosolized iloprost was started in the first patient and with aerosolized iloprost plus sildenafil in the second patient. Both patients were safely switched from IV iloprost to non-invasive combination therapy while WHO classification of functional status remained unchanged for at least 12 and 14 months, respectively. These data suggest that selected patients with complications due to IV iloprost treatment can be safely switched to non-IV combination therapies.
Halank
Michael
M
Department of Internal Medicine I, Carl Gustav Carus University, Dresden, Germany. Michael.Halank@uniklinikum-dresden.de
Kolditz
Martin
M
Opitz
Christian
C
Hoeffken
Gert
G
Ewert
Ralf
R
D000959:Antihypertensive Agents / Q000008:administration & dosage; D000077300:Bosentan; D004334:Drug Administration Schedule; D004338:Drug Combinations; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy*; D016285:Iloprost / Q000008:administration & dosage*; D007275:Injections, Intravenous; D008875:Middle Aged; D018579:Patient Selection; D010879:Piperazines / Q000008:administration & dosage*; D011651:Pulmonary Artery / Q000187:drug effects*; D011687:Purines; D000068677:Sildenafil Citrate; D013449:Sulfonamides / Q000008:administration & dosage*; D013450:Sulfones; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000008:administration & dosage
D000959:Antihypertensive Agents; D004338:Drug Combinations; D010879:Piperazines; D011687:Purines; D013449:Sulfonamides; D013450:Sulfones; D014665:Vasodilator Agents; D000068677:Sildenafil Citrate; D016285:Iloprost; D000077300:Bosentan