title: Treatment of sarcoidosis-associated pulmonary hypertension: A single centre retrospective experience using targeted therapies.
abstract: BACKGROUND
  Pulmonary hypertension (PH), an increasingly recognised complication of pulmonary sarcoidosis, is associated with increased morbidity and mortality Evidence of benefit with targeted therapies in sarcoidosis associated pulmonary hypertension (SAPH) is limited.
  
  
  METHODS
  We conducted a retrospective review of patients with sarcoidosis and right heart catheter proven PH who received treatment with targeted therapies (phosphodiesterase-5 inhibitors, endothelin receptor antagonists, or combination) at our hospital. Six minute walk test (6MWT), World Health Organisation (WHO) functional class, echocardiography, pulmonary function test (PFT) and serum brain natriuretic peptide (BNP) data were collected at baseline and during follow-up.
  
  
  RESULTS
  Thirty-three patients (16 men) with a mean age of 55.5 ± 10.7 years and mean pulmonary artery pressure of 44.0 ± 8.6 mm Hg received treatment with targeted PH therapies (sildenafil=29, bosentan=4). At six months, median six minute walk distance improved from 227 (88-526) meters to 240 (140-380) metres (p=0.04), median serum BNP levels improved from 35 (2-424) pmol/L to 26 (4-255) pmol/L (p<0.01), and at echocardiography, median tricuspid annular plane systolic excursion (TAPSE) improved from 17.5 (8.0-27.0) mm to 20.0 (15.0-27.0) mm (p=0.03). WHO functional class improved in 14 patients. Two patients developed side-effects attributed to sildenafil (n=1) or bosentan (n=1), requiring conversion to alternative PH therapies. Ten patients died, and one patient underwent lung transplantation, a median of 13.5 (3-37) months after commencing targeted therapies.
  
  
  CONCLUSIONS
  Our results suggest that targeted therapies are safe in patients with SAPH. Controlled trials are warranted before therapeutic recommendations can be made.
authors: Princess Alexandra Hospital. Gregory_Keir@health.qld.gov.au.
authors: Gregory John
authors: GJ
authors: Keir
authors: Simon L F
authors: SL
authors: Walsh
authors: Michael A
authors: MA
authors: Gatzoulis
authors: Philip S
authors: PS
authors: Marino
authors: Konstantinos
authors: K
authors: Dimopoulos
authors: Rafael
authors: R
authors: Alonso
authors: Sergio
authors: S
authors: Raposeiras-Roubin
authors: Elisabetta A
authors: EA
authors: Renzoni
authors: Toby M
authors: TM
authors: Maher
authors: Athol U
authors: AU
authors: Wells
authors: S John
authors: SJ
authors: Wort
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D062186:Arterial Pressure / Q000187:drug effects; D015415:Biomarkers / Q000097:blood; D065128:Endothelin Receptor Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D005080:Exercise Test; D017079:Exercise Tolerance / Q000187:drug effects; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality / Q000503:physiopathology; D008131:London; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D058990:Molecular Targeted Therapy; D020097:Natriuretic Peptide, Brain / Q000097:blood; D058986:Phosphodiesterase 5 Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D020127:Recovery of Function; D012189:Retrospective Studies; D017565:Sarcoidosis, Pulmonary / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D000959:Antihypertensive Agents; D015415:Biomarkers; D065128:Endothelin Receptor Antagonists; D058986:Phosphodiesterase 5 Inhibitors; D014665:Vasodilator Agents; D020097:Natriuretic Peptide, Brain