PMID- 15791043
OWN - NLM
STAT- MEDLINE
DCOM- 20051018
LR  - 20190819
IS  - 1346-9843 (Print)
IS  - 1346-9843 (Linking)
VI  - 69
IP  - 4
DP  - 2005 Apr
TI  - Oral sildenafil improves primary pulmonary hypertension refractory to 
      epoprostenol.
PG  - 461-5
AB  - BACKGROUND: Epoprostenol (prostaglandin I(2)) has become recognized as a 
      therapeutic breakthrough that can improve hemodynamics and survival in patients 
      with primary pulmonary hypertension (PPH). However, a significant number of 
      patients have PPH that is refractory to epoprostenol, and lung transplantation 
      has been the only remaining treatment option. METHODS AND RESULTS: The study 
      subjects included 20 consecutive patients with PPH (mean pulmonary arterial 
      pressure: 65+/-15 mmHg) who had received epoprostenol for more than 12 months. 
      The patients were divided into 2 groups; responders and non-responders. In the 
      non-responders, New York Heart Association (NYHA) functional class did not 
      improve and mean right atrial pressure (mRA) increased to 8 mmHg or more, and 
      additional sildenafil, a phosphodiesterase-5 inhibitor, was started. Six patients 
      were included in the non-responders, whose mRA was 9+/-5 mmHg before and 
      significantly increased to 13+/-3 mmHg after epoprostenol administration (p < 
      0.05). One patient died and the other 5 patients received oral sildenafil. The 
      mRA of 12+/-4 mmHg (value before sildenafil) improved to 8+/-5 mmHg after 
      sildenafil administration. Three patients were classified in the NYHA functional 
      class 4 and improved to class 3, and 2 patients were in class 3 and remained in 
      the same class after the addition of sildenafil. CONCLUSIONS: In patients with 
      severe PPH refractory to epoprostenol treatment, additional oral sildenafil can 
      improve pulmonary hemodynamics and symptoms. The combination therapy of 
      epoprostenol and sildenafil is a new medical treatment to attempt before 
      progressing to lung transplantation for patients with PPH refractory to 
      epoprostenol.
FAU - Kataoka, Masaharu
AU  - Kataoka M
AD  - Cardiopulmonary Division, Department of Medicine, Keio University School of 
      Medicine, Tokyo, Japan.
FAU - Satoh, Toru
AU  - Satoh T
FAU - Manabe, Tomohiro
AU  - Manabe T
FAU - Anzai, Toshihisa
AU  - Anzai T
FAU - Yoshikawa, Tsutomu
AU  - Yoshikawa T
FAU - Mitamura, Hideo
AU  - Mitamura H
FAU - Ogawa, Satoshi
AU  - Ogawa S
LA  - eng
PT  - Clinical Trial
PT  - Journal Article
PL  - Japan
TA  - Circ J
JT  - Circulation journal : official journal of the Japanese Circulation Society
JID - 101137683
RN  - 0 (Piperazines)
RN  - 0 (Purines)
RN  - 0 (Sulfones)
RN  - BW9B0ZE037 (Sildenafil Citrate)
RN  - DCR9Z582X0 (Epoprostenol)
SB  - IM
MH  - Administration, Oral
MH  - Adult
MH  - *Drug Resistance
MH  - Drug Synergism
MH  - Drug Therapy, Combination
MH  - Epoprostenol/administration & dosage/*therapeutic use
MH  - Female
MH  - Humans
MH  - Hypertension, Pulmonary/*drug therapy
MH  - Male
MH  - Middle Aged
MH  - Piperazines/*administration & dosage
MH  - Purines
MH  - Salvage Therapy/methods
MH  - Sildenafil Citrate
MH  - Sulfones
MH  - Treatment Outcome
EDAT- 2005/03/26 09:00
MHDA- 2005/10/19 09:00
CRDT- 2005/03/26 09:00
PHST- 2005/03/26 09:00 [pubmed]
PHST- 2005/10/19 09:00 [medline]
PHST- 2005/03/26 09:00 [entrez]
AID - JST.JSTAGE/circj/69.461 [pii]
AID - 10.1253/circj.69.461 [doi]
PST - ppublish
SO  - Circ J. 2005 Apr;69(4):461-5. doi: 10.1253/circj.69.461.