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- Title
Improving Survival in Patients with Pulmonary Arterial Hypertension: Focus on Intravenous Epoprostenol.
- Authors
Demerouti, Eftychia; Karyofyllis, Panagiotis; Manginas, Athanassios; Anthi, Anastasia; Karatasakis, George; Athanassopoulos, George; Voudris, Vassilios
- Abstract
Pulmonary arterial hypertension represents a devastating disease, causing progressive increase of pulmonary vascular resistance leading to right ventricular dysfunction and death. Therapeutic management has rapidly advanced in recent years due to improved understanding of pathophysiology and new drugs have been developed; however, survival remains poor. Oral agents as phosphodiesterase type V inhibitors, the soluble guanylyl cyclase stimulator riociguat, the prostacyclin receptor agonist selexipag and the endothelin receptor antagonists have each achieved evidence-based validation and are recommended for pulmonary arterial hypertension. Initial oral monotherapy or combination therapy is recommended for patients with low or intermediate risk according to each patient's risk stratification. Intravenous epoprostenol is a synthetic prostacyclin and the first drug approved for the disease. Although it represents the only treatment shown to reduce mortality, it is underused. Survival rates for patients treated with oral combination drug therapies are lower than those for patients treated with initial combination therapies including intravenous epoprostenol. This raises the interesting question of whether intermediate risk pulmonary arterial hypertension patients should be routinely introduced to therapies including intravenous epoprostenol rather than combination oral therapies.
- Subjects
PHOSPHODIESTERASE inhibitors; CELL receptors; COMBINATION drug therapy; INTRAVENOUS therapy; ORAL drug administration; PROSTACYCLIN; SURVIVAL; DRUG approval; PULMONARY hypertension; DISEASE progression; PROGNOSIS; THERAPEUTICS; HYPERTENSION risk factors
- Publication
American Journal of Cardiovascular Drugs, 2019, Vol 19, Issue 2, p99
- ISSN
1175-3277
- Publication type
Article
- DOI
10.1007/s40256-018-00319-z