PMID- 18403673
OWN - NLM
STAT- MEDLINE
DCOM- 20080815
LR  - 20181201
IS  - 0012-3692 (Print)
IS  - 0012-3692 (Linking)
VI  - 134
IP  - 1
DP  - 2008 Jul
TI  - Treprostinil-based therapy in the treatment of moderate-to-severe pulmonary 
      arterial hypertension: long-term efficacy and combination with bosentan.
PG  - 139-45
LID - 10.1378/chest.07-2111 [doi]
AB  - BACKGROUND: Treprostinil, a long-acting prostacyclin analog, diminished the 
      symptoms of pulmonary arterial hypertension (PAH) in controlled 12-week clinical 
      efficacy studies. This retrospective, single-center, open-label study was 
      designed to assess the efficacy of long-term, subcutaneously administered, 
      treprostinil-based therapy alone or in combination with bosentan for the 
      treatment of moderate-to-severe PAH. METHODS: Thirty-eight patients with 
      pulmonary hypertension treated with subcutaneous treprostinil were followed up 
      for a mean (+/-SD) duration of 984+/-468 days (range, 165 to 1,847 days). Oral 
      bosentan was added to the treprostinil regimen if patients remained in New York 
      Heart Association (NYHA) functional class III or II with intolerable prostacyclin 
      side effects that limited therapy. Hemodynamic studies, Borg dyspnea score 
      evaluations, 6-min walk (6MW) tests, and NYHA functional class determinations 
      were performed at approximately 6-month intervals. RESULTS: Mean pulmonary artery 
      pressure decreased from 59.7 to 50.5 mm Hg (p<0.001). Significant and sustained 
      improvement in 6MW distance (p=0.022) and Borg dyspnea score (p=0.023) were 
      observed. At the final observation, the mean dose of treprostinil was 37.8 
      ng/kg/min (range, 7.5 to 115 ng/kg/min). At baseline, 5% of patients were in NYHA 
      functional class 2 or lower vs 58% at the last follow-up. Bosentan was added to 
      the regimens of 19 patients. In those patients, significant additional 
      improvement occurred in the pulmonary arterial pressure (p<0.001), 6MW distance 
      (p=0.001), and Borg dyspnea scale (p=0.020) compared to baseline. CONCLUSIONS: 
      Long-term treatment with subcutaneous treprostinil-based therapy improved 
      functional parameters and hemodynamics in patients with moderate-to-severe PAH. 
      In patients requiring combination therapy, the addition of oral bosentan to 
      treprostinil-based therapy was safe, well-tolerated, and associated with further 
      clinical improvements.
FAU - Benza, Raymond L
AU  - Benza RL
AD  - Department of Medicine, Division of Cardiovascular Diseases, University of 
      Alabama at Birmingham, 321 THT, 1900 University Blvd, Birmingham, AL 35294, USA. 
      rbenza@uab.edu
FAU - Rayburn, Barry K
AU  - Rayburn BK
FAU - Tallaj, Jose A
AU  - Tallaj JA
FAU - Pamboukian, Salpy V
AU  - Pamboukian SV
FAU - Bourge, Robert C
AU  - Bourge RC
LA  - eng
PT  - Journal Article
DEP - 20080410
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  - Adolescent
MH  - Adult
MH  - Aged
MH  - Antihypertensive Agents/adverse effects/*therapeutic use
MH  - Blood Pressure/physiology
MH  - Bosentan
MH  - Drug Therapy, Combination
MH  - Dyspnea/physiopathology
MH  - Epoprostenol/adverse effects/*analogs & derivatives/therapeutic use
MH  - Exercise Tolerance/physiology
MH  - Female
MH  - Humans
MH  - Hypertension, Pulmonary/*drug therapy/physiopathology
MH  - Longitudinal Studies
MH  - Male
MH  - Middle Aged
MH  - Retrospective Studies
MH  - Severity of Illness Index
MH  - Sulfonamides/adverse effects/*therapeutic use
EDAT- 2008/04/12 09:00
MHDA- 2008/08/16 09:00
CRDT- 2008/04/12 09:00
PHST- 2008/04/12 09:00 [pubmed]
PHST- 2008/08/16 09:00 [medline]
PHST- 2008/04/12 09:00 [entrez]
AID - S0012-3692(08)60158-0 [pii]
AID - 10.1378/chest.07-2111 [doi]
PST - ppublish
SO  - Chest. 2008 Jul;134(1):139-45. doi: 10.1378/chest.07-2111. Epub 2008 Apr 10.