Science and Research

Survival with sildenafil and inhaled iloprost in a cohort with pulmonary hypertension: an observational study

BACKGROUND: Combination therapy is frequently used to treat patients with pulmonary hypertension but few studies have compared treatment regimens. This study examined the long-term effect of different combination regimens of inhaled iloprost and oral sildenafil on survival and disease progression. METHODS: This was a retrospective study of patients in the Giessen Pulmonary Hypertension Registry who received iloprost monotherapy followed by addition of sildenafil (iloprost/sildenafil), sildenafil monotherapy followed by addition of iloprost (sildenafil/iloprost), or upfront combination therapy (iloprost + sildenafil). The primary outcome was transplant-free survival (Kaplan-Meier analysis). When available, haemodynamic parameters and 6-minute-walk distance were evaluated. RESULTS: Overall, 148 patients were included. Baseline characteristics were similar across treatment groups; however, the iloprost + sildenafil cohort had higher mean pulmonary vascular resistance and pulmonary arterial pressure than the others. Transplant-free survival differed significantly between groups (P = 0.007, log-rank test). Cumulative transplant-free survival was highest for patients who received iloprost/sildenafil (1 year survival: iloprost/sildenafil, 95.1%; sildenafil/iloprost, 91.8%; iloprost + sildenafil, 62.9%); this group also remained on monotherapy significantly longer than the sildenafil/iloprost group (median 17.0 months vs 7.0 months, respectively; P = 0.004). Compared with pre-treatment values, mean 6-minute-walk distance increased significantly for all groups 3 months after beginning combination therapy. CONCLUSIONS: In this observational study of patients with pulmonary hypertension receiving combination therapy with iloprost and sildenafil, cumulative transplant-free survival was highest in those who received iloprost monotherapy initially. However, owing to the size and retrospective design of this study, further research is needed before making firm treatment recommendations.

  • Gall, H.; Sommer, N.; Milger, K.; Richter, M. J.; Voswinckel, R.; Bandorski, D.; Seeger, W.; Grimminger, F.; Ghofrani, H. A.

Keywords

  • Administration, Inhalation
  • Administration, Oral
  • Adult
  • Aged
  • Cohort Studies
  • Disease Progression
  • Drug Therapy, Combination
  • Female
  • Humans
  • Hypertension, Pulmonary/*drug therapy
  • Iloprost/*therapeutic use
  • Kaplan-Meier Estimate
  • Lung Transplantation
  • Male
  • Middle Aged
  • *Registries
  • Retrospective Studies
  • Sildenafil Citrate/*therapeutic use
  • Survival Rate
  • Vasodilator Agents/*therapeutic use
Publication details
DOI: 10.1186/s12890-015-0164-2
Journal: BMC pulmonary medicine
Pages: 5 
Work Type: Original
Location: UGMLC
Disease Area: PH
Partner / Member: JLU, MPI-BN
Access-Number: 26753921
See publication on PubMed

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