title: Randomized, prospective, placebo-controlled trial of bosentan in interstitial lung disease secondary to systemic sclerosis.
abstract: OBJECTIVE
  Endothelin is implicated as a participatory pathway in systemic sclerosis (SSc). We tested this hypothesis in a 12-month trial of bosentan, a nonselective endothelin receptor antagonist, as a therapy for SSc-related interstitial lung disease (ILD).
  
  
  METHODS
  Patients with SSc and significant ILD were recruited to this prospective, double-blind, randomized, placebo-controlled, parallel group study. The inclusion criteria were designed to select a cohort enriched for patients with active and progressive disease. Exclusion factors included significant pulmonary hypertension. Patients with a diffusing capacity for carbon monoxide of <80% predicted and a 6-minute walk distance of 150-500 meters or a 6-minute walk distance of > or = 500 meters with a decrease in oxygen saturation received bosentan or placebo. The primary efficacy end point was a change in the 6-minute walk distance from baseline up to month 12. Secondary end points included time to death or worsening results of pulmonary function tests (PFTs). The safety and tolerability of bosentan were also assessed.
  
  
  RESULTS
  Among the 163 patients, 77 were randomized to receive bosentan, and 86 were randomized to receive placebo. No significant difference between treatment groups was observed for change in the 6-minute walk distance up to month 12. No deaths occurred in this study group. Forced vital capacity and diffusing capacity for carbon monoxide remained stable in the majority of patients in both groups. Significant worsening of PFT results occurred in 25.6% of patients receiving placebo and 22.5% of those receiving bosentan (P not significant).
  
  
  CONCLUSIONS
  No improvement in exercise capacity was observed in the bosentan-treated group compared with the placebo group, and no significant treatment effect was observed for the other end points. Although many outcome variables were stable, bosentan did not reduce the frequency of clinically important worsening. These data do not support the use of endothelin receptor antagonists as therapy for ILD secondary to SSc.
authors.affiliation: Division of Rheumatology, University of Connecticut, Farmington, CT 06034, USA. jseibold@uchc.edu
authors.forename: J R
authors.initials: JR
authors.lastname: Seibold
authors.forename: C P
authors.initials: CP
authors.lastname: Denton
authors.forename: D E
authors.initials: DE
authors.lastname: Furst
authors.forename: L
authors.initials: L
authors.lastname: Guillevin
authors.forename: L J
authors.initials: LJ
authors.lastname: Rubin
authors.forename: A
authors.initials: A
authors.lastname: Wells
authors.forename: M
authors.initials: M
authors.lastname: Matucci Cerinic
authors.forename: G
authors.initials: G
authors.lastname: Riemekasten
authors.forename: P
authors.initials: P
authors.lastname: Emery
authors.forename: H
authors.initials: H
authors.lastname: Chadha-Boreham
authors.forename: P
authors.initials: P
authors.lastname: Charef
authors.forename: S
authors.initials: S
authors.lastname: Roux
authors.forename: C M
authors.initials: CM
authors.lastname: Black
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D000077300:Bosentan; D015897:Comorbidity; D004311:Double-Blind Method; D005080:Exercise Test; D005260:Female; D006801:Humans; D017563:Lung Diseases, Interstitial / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D012129:Respiratory Function Tests; D012595:Scleroderma, Systemic / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D013449:Sulfonamides / Q000627:therapeutic use*; D015996:Survival Rate; D055815:Young Adult
chemical_list: D000959:Antihypertensive Agents; D013449:Sulfonamides; D000077300:Bosentan