The current treatment of pulmonary arterial hypertension: time to redefine success.
In the past decade, three classes of medications have been approved for the treatment of pulmonary arterial hypertension. A review of the clinical trial data for the prostanoids, endothelin antagonists, and phosphodiesterase-5 inhibitors has shown that all agents have similar efficacy on the 6-min walk distance over 12 to 16 weeks, which was the primary end point in the randomized clinical trials. However, little is known about their long-term efficacy or about how these drugs affect the underlying disease, if at all. Successful therapy is currently defined as an improvement in exercise tolerance over a 4-month period. Future trials need to better characterize how therapies affect the pulmonary vasculature pathologically, biologically, and hemodynamically, and whether survival is actually improved.
Rich
Stuart
S
Section of Cardiology, University of Chicago, 5841 S Maryland Ave, MC 2016, Chicago, IL 60612, USA. srich@medicine.bsd.uchicago.edu
D000077300:Bosentan; D016232:Endothelins / Q000037:antagonists & inhibitors*; D011464:Epoprostenol / Q000627:therapeutic use; D005080:Exercise Test / Q000187:drug effects*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D008134:Long-Term Care; D010726:Phosphodiesterase Inhibitors / Q000627:therapeutic use*; D010879:Piperazines / Q000627:therapeutic use; D011453:Prostaglandins / Q000627:therapeutic use*; D011687:Purines; D016032:Randomized Controlled Trials as Topic; D000068677:Sildenafil Citrate; D013449:Sulfonamides / Q000627:therapeutic use; D013450:Sulfones; D016896:Treatment Outcome
D016232:Endothelins; D010726:Phosphodiesterase Inhibitors; D010879:Piperazines; D011453:Prostaglandins; D011687:Purines; D013449:Sulfonamides; D013450:Sulfones; D000068677:Sildenafil Citrate; D011464:Epoprostenol; D000077300:Bosentan