title: Intravenous epoprostenol versus high dose inhaled iloprost for long-term treatment of pulmonary hypertension.
abstract: BACKGROUND
  Intravenous prostacyclin (iv PGI) and inhaled Iloprost (inh ilo) are established therapies in pulmonary arterial hypertension (PAH), however comparative data are lacking.
  
  
  METHODS
  We performed a long-term open label comparison trial of iv PGI or high dose inh ilo in 24 patients with severe PAH: 12 patients (9 female, 40 +/- 14 years, 10 idiopathic PAH, 2 PAH in connective tissue disease CTD) received iv PGI, whereas 12 patients (7 female, 43 +/- 12 years, 5 IPAH, 6 CTD, 1 porto-pulmonary hypertension) were commenced on inh ilo with a median dose of 120 μg/24 h. Haemodynamic parameters and 6 min walking distance (6MWD) at baseline did not differ between both groups.
  
  
  RESULTS
  After 3 months therapy, patients on iv PGI showed a significant increase in 6MWD from 220 to 280 m (p < 0.01), whereas patients on high dose inh ilo increased 6MWD from 200 to 275 m (p < 0.05). The event free follow up was 23 [1-76] months in the iv PGI2I group, and 16 [7-38] months in the high dose inh ilo group (p < 0.05). Patients with a 6MWD ≥ 300 m after 3 months therapy had a significantly longer event free follow up [16 vs. 35 months; p < 0.004].
  
  
  CONCLUSIONS
  In this patient population with severe pulmonary hypertension of different etiologies, event free follow up on treatment with iv PGI is significantly longer compared to high dose inh ilo. The 6MWD after 3 months treatment might be predictive for long term outcome.
authors.affiliation: Pulmonary Vascular Diseases Unit Papworth Hospital, Cambridge, United Kingdom. frank.reichenberger@innere.med.uni-giessen.de
authors.forename: Frank
authors.initials: F
authors.lastname: Reichenberger
authors.forename: Ann
authors.initials: A
authors.lastname: Mainwood
authors.forename: Nicholas W
authors.initials: NW
authors.lastname: Morrell
authors.forename: Jayan
authors.initials: J
authors.lastname: Parameshwar
authors.forename: Joanna
authors.initials: J
authors.lastname: Pepke-Zaba
mesh_terms: D000280:Administration, Inhalation; D000293:Adolescent; D000328:Adult; D011464:Epoprostenol / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy* / Q000503:physiopathology; D016285:Iloprost / Q000008:administration & dosage*; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged
chemical_list: D011464:Epoprostenol; D016285:Iloprost