Prostacyclin for pulmonary hypertension

Intravenous prostacyclin over 12 weeks appears to improve exercise capacity, NYHA functional class and several cardiopulmonary haemodynamic variables in patients with pulmonary hypertension.

A Cochrane review included 9 RCTs of mixed duration (3 days–52 weeks) with a total of 1175 participants (NYHA functional classes II-IV).

• Intravenous prostacyclin versus usual care (4 studies): There were significant improvements in exercise capacity of around 90 metres (SMD 0.69, 95% CI 0.40 to 0.97; 3 trials), cardiopulmonary haemodynamics and NYHA functional class over 3 days–12 weeks. Effects were consistent in primary and secondary pulmonary hypertension.
• Oral prostacyclin versus placebo (2 studies): Short-term data (3–6 months) indicated that there was a significant improvement in exercise capacity, but data from one study of 52 weeks reported no significant difference at 12 months. No significant differences were observed for any other outcome.
• Subcutaneous treprostinil versus placebo (2 studies, 8–12 weeks): One large study reported a significant median improvement in exercise capacity of around 16 metres. Cardiopulmonary haemodynamics and symptom scores favoured treprostinil. Infusion site pain and withdrawals due to adverse events were more frequent with treprostinil.
• Inhaled prostacyclin versus placebo (1 study, 12 weeks): There was a significant increase in exercise capacity of approximately 36 metres. Treatment led to better symptom scores and functional class status than with placebo.

Subgroup analyses reported by individual studies showed a better exercise capacity in participants with PPH, than those participants with PH secondary to other diseases. Side effects and adverse events were common in the studies.

Ədəbiyyat

1. Paramothayan NS, Lasserson TJ, Wells AU, Walters EH. Prostacyclin for pulmonary hypertension in adults. Cochrane Database Syst Rev 2005 Apr 18;(2):CD002994.