PMID- 17099026
OWN - NLM
STAT- MEDLINE
DCOM- 20061214
LR  - 20181201
IS  - 0012-3692 (Print)
IS  - 0012-3692 (Linking)
VI  - 130
IP  - 5
DP  - 2006 Nov
TI  - Conversion to bosentan from prostacyclin infusion therapy in pulmonary arterial 
      hypertension: a pilot study.
PG  - 1471-80
AB  - STUDY OBJECTIVES: We assessed the efficacy of bosentan in transitioning from 
      prostacyclin infusions in patients with pulmonary arterial hypertension (PAH). 
      METHODS: Twenty-two PAH patients were recruited from five PAH centers if they had 
      been clinically stable while receiving therapy with IV epoprostenol or 
      subcutaneous treprostinil for at least 3 months. Patients were observed in an 
      open-label prospective trial while bosentan was added to therapy, and then 
      epoprostenol or treprostinil were tapered after 2 months. RESULTS: Ten of the 22 
      patients were transitioned off prostacyclin infusion therapy after a mean (+/- 
      SEM) duration of 6.1 +/- 1.2 months. Of those patients, seven patients have 
      continued not receiving prostacyclin infusion therapy for a mean duration of 17.7 
      +/- 5.3 months, with no significant changes in pulmonary artery (PA) pressure 
      estimated by echocardiography, World Health Organization (WHO)/New York Heart 
      Association (NYHA) functional class, 6-min walk distance (6MWD), or Borg dyspnea 
      score. The conditions of three patients deteriorated, necessitating the 
      resumption of prostacyclin therapy, and two patients subsequently died. Twelve 
      patients failed to transition or even lower the prostacylin infusion rate and had 
      worsening of their WHO/NYHA functional class and estimated systolic PA pressures, 
      and had a trend toward deterioration in their mean 6MWD (294 +/- 41 to 198 +/- 34 
      m, respectively; p = 0.2). Of these, two patients subsequently died. The baseline 
      characteristics of those who transitioned successfully vs those who transitioned 
      unsuccessfully were a lower prostacyclin infusion rate, and less severe 
      elevations in the mean and estimated systolic PA pressures. CONCLUSION: 
      Transitioning from therapy with prostacyclin to bosentan is possible in some PAH 
      patients, mainly in those receiving lower prostacyclin doses and having less 
      pulmonary hypertension at baseline. Careful patient selection and close interim 
      monitoring is needed because the conditions of patients can deteriorate, and they 
      may not respond to the resumption of therapy with prostacyclin.
FAU - Steiner, M Kathryn
AU  - Steiner MK
AD  - Tufts-New England Medical Center, Boston, MA, USA. ksteiner@partners.org
FAU - Preston, Ioana R
AU  - Preston IR
FAU - Klinger, James R
AU  - Klinger JR
FAU - Criner, Gerard J
AU  - Criner GJ
FAU - Waxman, Aaron B
AU  - Waxman AB
FAU - Farber, Harrison W
AU  - Farber HW
FAU - Hill, Nicholas S
AU  - Hill NS
LA  - eng
PT  - Clinical Trial
PT  - Journal Article
PT  - Multicenter Study
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Chest
JT  - Chest
JID - 0231335
RN  - 0 (Antihypertensive Agents)
RN  - 0 (Sulfonamides)
RN  - DCR9Z582X0 (Epoprostenol)
RN  - Q326023R30 (Bosentan)
RN  - RUM6K67ESG (treprostinil)
SB  - IM
MH  - Administration, Oral
MH  - Adult
MH  - Aged
MH  - Antihypertensive Agents/adverse effects/*therapeutic use
MH  - Blood Pressure/drug effects/physiology
MH  - Bosentan
MH  - Dose-Response Relationship, Drug
MH  - Epoprostenol/adverse effects/*analogs & derivatives/pharmacology/*therapeutic use
MH  - Female
MH  - Humans
MH  - Hypertension, Pulmonary/*drug therapy/physiopathology
MH  - Infusions, Intravenous
MH  - Lung/blood supply/drug effects/physiopathology
MH  - Middle Aged
MH  - Physical Endurance/drug effects/physiology
MH  - Pilot Projects
MH  - Severity of Illness Index
MH  - Sulfonamides/adverse effects/*therapeutic use
MH  - Walking/physiology
EDAT- 2006/11/14 09:00
MHDA- 2006/12/15 09:00
CRDT- 2006/11/14 09:00
PHST- 2006/11/14 09:00 [pubmed]
PHST- 2006/12/15 09:00 [medline]
PHST- 2006/11/14 09:00 [entrez]
AID - S0012-3692(15)37325-6 [pii]
AID - 10.1378/chest.130.5.1471 [doi]
PST - ppublish
SO  - Chest. 2006 Nov;130(5):1471-80. doi: 10.1378/chest.130.5.1471.