PMID- 19107243
OWN - NLM
STAT- MEDLINE
DCOM- 20090224
LR  - 20211020
IS  - 1198-2241 (Print)
IS  - 1916-7245 (Electronic)
IS  - 1198-2241 (Linking)
VI  - 15
IP  - 8
DP  - 2008 Nov-Dec
TI  - Addition of sildenafil in patients with pulmonary arterial hypertension with 
      inadequate response to bosentan monotherapy.
PG  - 427-30
AB  - BACKGROUND: Pulmonary arterial hypertension (PAH) remains a progressive disease 
      despite improvement when using one of three medication classes: prostanoids, 
      endothelin receptor antagonists or phosphodiesterase-5 inhibitors. Combination 
      therapy has been proposed for patients with unsatisfactory response to 
      monotherapy. OBJECTIVES: To examine the effect of adding sildenafil to bosentan 
      on 6 min walk distance (6MWD) and New York Heart Association (NYHA) 
      classification in patients with PAH who achieved inadequate improvement with 
      bosentan monotherapy. METHODS: Patients with idiopathic PAH or connective tissue 
      disease-associated PAH, and who had either self-reported inadequate improvement 
      in exercise tolerance or a decline in 6MWD after initial improvement, were 
      included in the study (n=10). Data on 6MWD and NYHA class at baseline (before 
      initiation of bosentan), three and six months after baseline, second baseline 
      (before initiation of combination therapy with sildenafil), and three and six 
      months after second baseline were analyzed for any changes. RESULTS: Mean time 
      from initiation of bosentan monotherapy to initiation of combination therapy was 
      558 days (range 150 to 900 days). Six months after initiation of bosentan, 6MWD 
      increased by 57.2 m above the baseline of 314.4 m. Six months after combination 
      therapy, 6MWD was 62.80 m higher than the baseline before initiation of 
      combination therapy of 339 m (P<0.02). The overall increase in 6MWD six months 
      after combination therapy was higher than the first baseline by 87.4 m (P not 
      significant). NYHA functional class did not improve with combination therapy in 
      all patients. DISCUSSION: Initiating combination therapy in patients who achieve 
      an inadequate improvement in exercise tolerance with monotherapy may result in 
      further improvement in exercise tolerance.
FAU - Porhownik, Nancy R
AU  - Porhownik NR
AD  - University of Manitoba, Winnipeg, Canada. umporho0@cc.umanitoba.ca
FAU - Al-Sharif, Hassan
AU  - Al-Sharif H
FAU - Bshouty, Zoheir
AU  - Bshouty Z
LA  - eng
PT  - Journal Article
PL  - Egypt
TA  - Can Respir J
JT  - Canadian respiratory journal
JID - 9433332
RN  - 0 (Antihypertensive Agents)
RN  - 0 (Phosphodiesterase Inhibitors)
RN  - 0 (Piperazines)
RN  - 0 (Purines)
RN  - 0 (Sulfonamides)
RN  - 0 (Sulfones)
RN  - BW9B0ZE037 (Sildenafil Citrate)
RN  - Q326023R30 (Bosentan)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Antihypertensive Agents/*administration & dosage
MH  - Bosentan
MH  - Drug Therapy, Combination
MH  - Exercise Tolerance
MH  - Female
MH  - Humans
MH  - Hypertension, Pulmonary/*drug therapy
MH  - Male
MH  - Middle Aged
MH  - Phosphodiesterase Inhibitors/*administration & dosage
MH  - Piperazines/*administration & dosage
MH  - Purines/administration & dosage
MH  - Sildenafil Citrate
MH  - Sulfonamides/*administration & dosage
MH  - Sulfones/*administration & dosage
MH  - Treatment Failure
MH  - Young Adult
PMC - PMC2682165
EDAT- 2008/12/25 09:00
MHDA- 2009/02/25 09:00
PMCR- 2009/11/01
CRDT- 2008/12/25 09:00
PHST- 2008/12/25 09:00 [entrez]
PHST- 2008/12/25 09:00 [pubmed]
PHST- 2009/02/25 09:00 [medline]
PHST- 2009/11/01 00:00 [pmc-release]
AID - crj15427 [pii]
AID - 10.1155/2008/897102 [doi]
PST - ppublish
SO  - Can Respir J. 2008 Nov-Dec;15(8):427-30. doi: 10.1155/2008/897102.