HOME SUBSCRIPTIONS CURRENT ISSUE PAST ISSUES CARDIOSOURCE SEARCH HELP FEEDBACK		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Badesch, D. B. Articles by Barst, R. J. Search for Related Content PubMed Articles by Badesch, D. B. Articles by Barst, R. J.

Prostanoid therapy for pulmonary arterial hypertension

David B. Badesch, MD^*,*, Vallerie V. McLaughlin, MD, Marion Delcroix, MD, CarmineDario Vizza, MD, Horst Olschewski, MD^||, Olivier Sitbon, MD^¶ and Robyn J. Barst, MD

^* University of Colorado Health Sciences Center, Denver, Colorado, USA
University of Michigan, Ann Arbor, Michigan, USA
University Hospital Gasthuisberg, Leuven, Belgium
University of Roma "La Sapienza," Rome, Italy
^|| University Hospital, Justus-Liebig-University, Giessen, Germany
^¶ Hôpital Antoine Béclère, Clamart, France
Columbia University College of Physicians and Surgeons, New York, New York, USA

Manuscript received November 26, 2003; accepted February 3, 2004.

^* Reprint requests and correspondence: Dr. David B. Badesch, Divisions of Pulmonary Sciences and Critical Care Medicine, and Cardiology, University of Colorado Health Sciences Center, Box C-272, 4200 East Ninth Avenue, Denver, Colorado 80262, USA.
David.Badesch{at}UCHSC.edu

Prostanoids have played a prominent role in the treatment of pulmonary arterial hypertension (PAH). Several compounds and methods of administration have been studied: chronic intravenously infused epoprostenol, chronic subcutaneously infused treprostinil, inhaled iloprost, and oral beraprost. Chronic intravenous epoprostenol therapy has had a substantial impact on the clinical management of patients with severe PAH. It improves exercise capacity, hemodynamics, and survival in patients with idiopathic pulmonary arterial hypertension (IPAH). It also improves exercise capacity and hemodynamics in patients with PAH occurring in association with scleroderma. The complexity of epoprostenol therapy (chronic indwelling catheters, reconstitution of the drug, operation of the infusion pump, and others) has led to attempts to develop other prostanoids with simpler modes of delivery. Treprostinil, a stable prostacyclin analogue with a half-life of 3 h, has been developed for subcutaneous delivery. It has beneficial effects on exercise and hemodynamics, which depend somewhat on the dose achieved. This, in turn, is determined by the patient's ability to tolerate the drug's side effects, including pain and erythema at the infusion site. Inhaled iloprost therapy may provide selectivity of the hemodynamic effects to the lung vasculature, thus avoiding systemic side effects. In a randomized and controlled trial, iloprost resulted in improvement in a combined end point incorporating the New York Heart Association functional class, 6-min walk test, and deterioration or death. Beraprost is the first orally active prostacyclin analogue. In the first of two randomized controlled trials, beraprost increased exercise capacity in patients with IPAH, with no significant changes in subjects with associated conditions. Hemodynamics did not change significantly, and no difference in survival was detected between the two treatment groups. The second study showed that beraprost-treated patients had less disease progression at six months and confirmed the results of the previous trial. However, this improvement was no longer present at 9 or 12 months. In conclusion, though treatment with prostanoids is complicated by their generally short half-lives and complicated drug delivery systems, they continue to play an important role in the treatment of PAH.

Abbreviations and Acronyms   IPAH = idiopathic pulmonary arterial hypertension   IV = intravenous   NO = nitric oxide   NYHA = New York Heart Association   PAH = pulmonary arterial hypertension   PPH = primary pulmonary hypertension

This article has been cited by other articles:

				H. Obata, Y. Sakai, S. Ohnishi, S. Takeshita, H. Mori, M. Kodama, K. Kangawa, Y. Aizawa, and N. Nagaya Single Injection of a Sustained-release Prostacyclin Analog Improves Pulmonary Hypertension in Rats Am. J. Respir. Crit. Care Med., January 15, 2008; 177(2): 195 - 201. [Abstract] [Full Text] [PDF]

				N. M. Patel, D. J. Lederer, A. C. Borczuk, and S. M. Kawut Pulmonary Hypertension in Idiopathic Pulmonary Fibrosis Chest, September 1, 2007; 132(3): 998 - 1006. [Abstract] [Full Text] [PDF]

				A. E Lammers, A. A Hislop, Y. Flynn, and S. G Haworth Epoprostenol treatment in children with severe pulmonary hypertension Heart, June 1, 2007; 93(6): 739 - 743. [Abstract] [Full Text] [PDF]

				M. S. McMurtry, R. Moudgil, K. Hashimoto, S. Bonnet, E. D. Michelakis, and S. L. Archer Overexpression of human bone morphogenetic protein receptor 2 does not ameliorate monocrotaline pulmonary arterial hypertension Am J Physiol Lung Cell Mol Physiol, April 1, 2007; 292(4): L872 - L878. [Abstract] [Full Text] [PDF]

				G.-P. Diller and M. A. Gatzoulis Pulmonary Vascular Disease in Adults With Congenital Heart Disease Circulation, February 27, 2007; 115(8): 1039 - 1050. [Abstract] [Full Text] [PDF]

				N. Collins, B. Bastian, L. Quiqueree, C. Jones, R. Morgan, and G. Reeves Abnormal pulmonary vascular responses in patients registered with a systemic autoimmunity database: Pulmonary Hypertension Assessment and Screening Evaluation using stress echocardiography (PHASE-I) Eur J Echocardiogr, December 1, 2006; 7(6): 439 - 446. [Abstract] [Full Text] [PDF]

				R. Voswinckel, B. Enke, F. Reichenberger, M. Kohstall, A. Kreckel, S. Krick, H. Gall, T. Gessler, T. Schmehl, H. A. Ghofrani, et al. Favorable Effects of Inhaled Treprostinil in Severe Pulmonary Hypertension: Results From Randomized Controlled Pilot Studies J. Am. Coll. Cardiol., October 17, 2006; 48(8): 1672 - 1681. [Abstract] [Full Text] [PDF]

				M. Kataoka, N. Nagaya, T. Satoh, T. Itoh, S. Murakami, T. Iwase, Y. Miyahara, S. Kyotani, Y. Sakai, K. Kangawa, et al. A Long-Acting Prostacyclin Agonist with Thromboxane Inhibitory Activity for Pulmonary Hypertension Am. J. Respir. Crit. Care Med., December 15, 2005; 172(12): 1575 - 1580. [Abstract] [Full Text] [PDF]

				M. R. Nicolls, L. Taraseviciene-Stewart, P. R. Rai, D. B. Badesch, and N. F. Voelkel Autoimmunity and pulmonary hypertension: a perspective Eur. Respir. J., December 1, 2005; 26(6): 1110 - 1118. [Abstract] [Full Text] [PDF]

				K. Ford Pulmonary artery hypertension: new drug treatment in children Arch. Dis. Child. Ed. Pract., June 1, 2005; 90(1): ep15 - ep20. [Full Text] [PDF]

				E. Weitzenblum and A. Chaouat Severe Pulmonary Hypertension in COPD: Is It a Distinct Disease? Chest, May 1, 2005; 127(5): 1480 - 1482. [Full Text] [PDF]