Document Detail

Transition from epoprostenol and treprostinil to the oral endothelin receptor antagonist bosentan in patients with pulmonary hypertension.
MedLine Citation:
PMID:  15364760     Owner:  NLM     Status:  MEDLINE    
STUDY OBJECTIVES: Prior to the availability of the oral endothelin antagonist bosentan, most patients with pulmonary arterial hypertension (PAH) were treated with continuously infused prostacyclins. Many patients receiving prostacyclins would have received bosentan if it had been available at the time of their diagnosis. Noninvasive criteria (symptoms, World Health Organization [WHO] functional class, 6-min walk test [6MWT] distances, and echocardiograms) are used to govern up-titration of prostacyclins and to assess response to bosentan. The purposes of this study were to see if some patients might be able to transition safely from prostacyclin to bosentan, and whether noninvasive criteria could be used to monitor this transition.
METHODS: From January 2002 to July 2003, 23 stable patients with PAH attempted a transition from prostacyclin to bosentan over an 8-week period. 6MWT results, WHO class, and echocardiograms were recorded prior to transition and 1 month after successful transition. The transition was stopped and prostacyclin was resumed or up-titrated if any symptoms of PAH worsened.
RESULTS: Of 23 candidates (19 female and 4 male; age range, 17 to 73 years), 15 patients were transitioned to bosentan. Of these patients, four patients experienced worsening symptoms (range, 7 weeks to 12 months after cessation of prostacyclin) and resumed treatment with prostacyclin. Of the remaining 11 patients, 2 patients had liver function abnormalities 3 months and 10 months after transition to bosentan, respectively; 9 patients remained on bosentan 3 to 16 months after prostacyclin cessation. Patients failing transition and resuming prostacyclin returned to their pretransition functional baseline.
CONCLUSION: Nine of 23 carefully selected, stable patients with PAH receiving long-term prostacyclin were successfully transitioned to oral bosentan using noninvasive monitoring. No long-term adverse events were associated with failed transition attempts. Further studies need to be carried out to determine which patients are more likely to undergo the transition successfully.
Nizar Suleman; Adaani E Frost
Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Chest     Volume:  126     ISSN:  0012-3692     ISO Abbreviation:  Chest     Publication Date:  2004 Sep 
Date Detail:
Created Date:  2004-09-14     Completed Date:  2004-11-02     Revised Date:  2013-06-18    
Medline Journal Info:
Nlm Unique ID:  0231335     Medline TA:  Chest     Country:  United States    
Other Details:
Languages:  eng     Pagination:  808-15     Citation Subset:  AIM; IM    
Baylor College of Medicine, The Methodist Hospital, Houston, TX 77030, USA.
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MeSH Terms
Administration, Oral
Antihypertensive Agents / administration & dosage*,  adverse effects
Epoprostenol / administration & dosage*,  adverse effects,  analogs & derivatives*
Hypertension, Pulmonary / drug therapy*
Infusions, Intravenous
Long-Term Care
Middle Aged
Receptors, Endothelin / antagonists & inhibitors*
Substance Withdrawal Syndrome / drug therapy,  etiology
Sulfonamides / administration & dosage*,  adverse effects
Treatment Outcome
Reg. No./Substance:
0/Antihypertensive Agents; 0/Receptors, Endothelin; 0/Sulfonamides; 0/treprostinil; 35121-78-9/Epoprostenol; Q326023R30/bosentan

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