PMID- 28705306 OWN - NLM STAT- MEDLINE DCOM- 20171027 LR - 20220408 IS - 2212-5353 (Electronic) IS - 2212-5345 (Linking) VI - 55 IP - 4 DP - 2017 Jul TI - Riociguat for patients with chronic thromboembolic pulmonary hypertension: Usefulness of transitioning from phosphodiesterase type 5 inhibitor. PG - 270-275 LID - S2212-5345(17)30061-8 [pii] LID - 10.1016/j.resinv.2017.04.004 [doi] AB - BACKGROUND: Riociguat, the first approved drug for patients with chronic thromboembolic pulmonary hypertension (CTEPH), is a soluble guanylate cyclase (sGC) Stimulator. It directly stimulates sGC independently of nitric oxide (NO) and increases sGC sensitivity for NO. The safety and efficacy of transitioning from a phosphodiesterase 5 inhibitor (PDE5i) to riociguat is unknown. METHODS AND RESULTS: Twenty-three patients were prospectively enrolled: 8 symptomatic patients with inadequate clinical responses to PDE5i were changed to riociguat (transitioned group); 15 started riociguat anew (new or add-on group). We analyzed the change from baseline to 6-12 months of riociguat treatment for the 6-minute walk distance (6MWD), mean pulmonary arterial pressure (mPAP), pulmonary vascular resistance (PVR), cardiac index (CI), partial pressure of oxygen in arterial blood (PaO2), brain natriuretic peptide (BNP), World Health Organization (WHO) functional class, safety and adverse events. The mPAP, BNP and WHO functional class significantly improved in total. In the transitioned group, BNP significantly decreased by -116.5+/-188.6pg/ml (P=0.0156). The 6MWD, mPAP, PVR, CI, and PaO2 improved but not significantly. The baseline condition was significantly more severe in the transitioned than in the new or add-on group. No patients discontinued riociguat. Relatively rapid transitioning from PDE5i to riociguat was safe under careful observation. CONCLUSIONS: Transitioning to riociguat may be safe and effective in CTEPH patients with inadequate clinical responses to PDE5i. CI - Copyright (c) 2017 The Japanese Respiratory Society. Published by Elsevier B.V. All rights reserved. FAU - Yamamoto, Keiko AU - Yamamoto K AD - Department of Respirology, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan. Electronic address: shiitake@mx7.ttcn.ne.jp. FAU - Tanabe, Nobuhiro AU - Tanabe N AD - Department of Respirology, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan; Department of Advanced Medicine in Pulmonary Hypertension, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan. FAU - Suda, Rika AU - Suda R AD - Department of Advanced Medicine in Pulmonary Hypertension, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan. FAU - Sasaki, Akane AU - Sasaki A AD - Department of Respirology, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan. FAU - Matsumura, Akane AU - Matsumura A AD - Department of Respirology, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan. FAU - Ema, Ryogo AU - Ema R AD - Department of Respirology, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan. FAU - Kasai, Hajime AU - Kasai H AD - Department of Respirology, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan. FAU - Kato, Fumiaki AU - Kato F AD - Department of Respirology, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan. FAU - Sekine, Ayumi AU - Sekine A AD - Department of Respirology, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan; Department of Advanced Medicine in Pulmonary Hypertension, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan. FAU - Nishimura, Rintaro AU - Nishimura R AD - Department of Respirology, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan; Department of Advanced Medicine in Pulmonary Hypertension, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan. FAU - Jujo, Takayuki AU - Jujo T AD - Department of Respirology, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan; Department of Advanced Medicine in Pulmonary Hypertension, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan. FAU - Sugiura, Toshihiko AU - Sugiura T AD - Department of Respirology, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan. FAU - Shigeta, Ayako AU - Shigeta A AD - Department of Respirology, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan. FAU - Sakao, Seiichiro AU - Sakao S AD - Department of Respirology, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan. FAU - Tatsumi, Koichiro AU - Tatsumi K AD - Department of Respirology, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan. LA - eng PT - Journal Article DEP - 20170619 PL - Netherlands TA - Respir Investig JT - Respiratory investigation JID - 101581124 RN - 0 (Phosphodiesterase 5 Inhibitors) RN - 0 (Pyrazoles) RN - 0 (Pyrimidines) RN - 114471-18-0 (Natriuretic Peptide, Brain) RN - RU3FE2Y4XI (riociguat) SB - IM MH - Aged MH - Arterial Pressure MH - Chronic Disease MH - *Drug Substitution MH - Female MH - Humans MH - Hypertension, Pulmonary/*drug therapy/metabolism/physiopathology MH - Male MH - Middle Aged MH - Natriuretic Peptide, Brain/metabolism MH - Oxygen Consumption MH - Partial Pressure MH - Phosphodiesterase 5 Inhibitors/*therapeutic use MH - Pulmonary Artery/physiopathology MH - Pulmonary Embolism/*drug therapy/metabolism/physiopathology MH - Pyrazoles/*therapeutic use MH - Pyrimidines/*therapeutic use MH - Time Factors MH - Vascular Resistance MH - Walk Test OTO - NOTNLM OT - Chronic thromboembolic pulmonary hypertension OT - Mean pulmonary arterial pressure OT - Phosphodiesterase 5 inhibitor OT - Soluble guanylate cyclase stimulator EDAT- 2017/07/15 06:00 MHDA- 2017/10/28 06:00 CRDT- 2017/07/15 06:00 PHST- 2016/10/03 00:00 [received] PHST- 2017/03/17 00:00 [revised] PHST- 2017/04/27 00:00 [accepted] PHST- 2017/07/15 06:00 [entrez] PHST- 2017/07/15 06:00 [pubmed] PHST- 2017/10/28 06:00 [medline] AID - S2212-5345(17)30061-8 [pii] AID - 10.1016/j.resinv.2017.04.004 [doi] PST - ppublish SO - Respir Investig. 2017 Jul;55(4):270-275. doi: 10.1016/j.resinv.2017.04.004. Epub 2017 Jun 19.