Poor outcome of patients with pulmonary arterial hypertension with insufficient response to phosphodiesterase-5 inhibitors alone or in combination with other specific therapy: a registry-based study
Phosphodiesterase-5 inhibitors are commonly used in pulmonary arterial hypertension but, as suggested by the RESPITE study, phosphodiesterase-5 inhibitor therapy (mono-/combination) does not always have a satisfactory treatment effect. This study aimed to investigate the clinical course of pulmonary...
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doaj-695b206b17b349f788ffcaaf509b1a4f2020-11-25T04:04:26ZengSAGE PublishingPulmonary Circulation2045-89402020-09-011010.1177/2045894020958557Poor outcome of patients with pulmonary arterial hypertension with insufficient response to phosphodiesterase-5 inhibitors alone or in combination with other specific therapy: a registry-based studyClara Hjalmarsson0Oisin Butler1Roger Hesselstrand2Katsiaryna Holl3Kjell Jansson4Rogier Klok5Göran Rådegran6Stefan Söderberg7Barbro Kjellström8Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Gothenburg University, and Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, SwedenBayer AG, Berlin, GermanyDepartment of Clinical Sciences Lund, Rheumatology, Lund University, and Skåne University Hospital, Lund, SwedenBayer AG, Berlin, GermanyDepartment of Cardiology and Department of Clinical Physiology, Institution of Medicine and Health Sciences, Linköping University, Linköping SwedenMerck & Co., Inc., Kenilworth, NJ, USADepartment of Clinical Sciences Lund, Cardiology, The Section for Heart Failure and Valvular Disease, Lund University, and Skåne University Hospital, Lund, SwedenDepartment of Public Health and Clinical Medicine, and Heart Centre, Umeå University, Umeå, SwedenCardiology Unit, Department of Medicine, Karolinska Institute, Stockholm, SwedenPhosphodiesterase-5 inhibitors are commonly used in pulmonary arterial hypertension but, as suggested by the RESPITE study, phosphodiesterase-5 inhibitor therapy (mono-/combination) does not always have a satisfactory treatment effect. This study aimed to investigate the clinical course of pulmonary arterial hypertension patients not at treatment goal after at least 90 days of treatment with phosphodiesterase-5 inhibitors, alone or in combination with other pulmonary arterial hypertension therapies. The study included 106 incident patients from the Swedish Pulmonary Arterial Hypertension Registry, treated with phosphodiesterase-5 inhibitors for ≥90 days, who were not at a pre-specified treatment goal, i.e. in World Health Organisation functional class III, with 6-min walking distance 165–440 m, and N-terminal prohormone of brain natriuretic peptide >300 ng/L. Changes in World Health Organisation functional class, 6-min walking distance, N-terminal prohormone of brain natriuretic peptide, and risk group between index and follow-up were assessed. Of patients with complete follow-up data, ( n = 53) 77% were on combination therapy and risk assessment yielded 98% at intermediate risk at index. At follow-up, 11 patients transitioned from World Health Organisation functional class III to World Health Organisation functional class II, the median (Q1; Q3) change in 6-min walking distance was 6 (−30; 42) meters and in N-terminal prohormone of brain natriuretic peptide 47 (−410; 603) ng/L, while 89% remained at an intermediate risk. Of those without complete follow-up data, 11 patients died and 2 underwent lung transplantation. In conclusion, pulmonary arterial hypertension patients treated with phosphodiesterase-5 inhibitors, as single or combination therapy and not achieving the pre-specified treatment goals after ≥90 days have an unfavourable clinical course.https://doi.org/10.1177/2045894020958557 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Clara Hjalmarsson Oisin Butler Roger Hesselstrand Katsiaryna Holl Kjell Jansson Rogier Klok Göran Rådegran Stefan Söderberg Barbro Kjellström |
spellingShingle |
Clara Hjalmarsson Oisin Butler Roger Hesselstrand Katsiaryna Holl Kjell Jansson Rogier Klok Göran Rådegran Stefan Söderberg Barbro Kjellström Poor outcome of patients with pulmonary arterial hypertension with insufficient response to phosphodiesterase-5 inhibitors alone or in combination with other specific therapy: a registry-based study Pulmonary Circulation |
author_facet |
Clara Hjalmarsson Oisin Butler Roger Hesselstrand Katsiaryna Holl Kjell Jansson Rogier Klok Göran Rådegran Stefan Söderberg Barbro Kjellström |
author_sort |
Clara Hjalmarsson |
title |
Poor outcome of patients with pulmonary arterial hypertension with insufficient response to phosphodiesterase-5 inhibitors alone or in combination with other specific therapy: a registry-based study |
title_short |
Poor outcome of patients with pulmonary arterial hypertension with insufficient response to phosphodiesterase-5 inhibitors alone or in combination with other specific therapy: a registry-based study |
title_full |
Poor outcome of patients with pulmonary arterial hypertension with insufficient response to phosphodiesterase-5 inhibitors alone or in combination with other specific therapy: a registry-based study |
title_fullStr |
Poor outcome of patients with pulmonary arterial hypertension with insufficient response to phosphodiesterase-5 inhibitors alone or in combination with other specific therapy: a registry-based study |
title_full_unstemmed |
Poor outcome of patients with pulmonary arterial hypertension with insufficient response to phosphodiesterase-5 inhibitors alone or in combination with other specific therapy: a registry-based study |
title_sort |
poor outcome of patients with pulmonary arterial hypertension with insufficient response to phosphodiesterase-5 inhibitors alone or in combination with other specific therapy: a registry-based study |
publisher |
SAGE Publishing |
series |
Pulmonary Circulation |
issn |
2045-8940 |
publishDate |
2020-09-01 |
description |
Phosphodiesterase-5 inhibitors are commonly used in pulmonary arterial hypertension but, as suggested by the RESPITE study, phosphodiesterase-5 inhibitor therapy (mono-/combination) does not always have a satisfactory treatment effect. This study aimed to investigate the clinical course of pulmonary arterial hypertension patients not at treatment goal after at least 90 days of treatment with phosphodiesterase-5 inhibitors, alone or in combination with other pulmonary arterial hypertension therapies. The study included 106 incident patients from the Swedish Pulmonary Arterial Hypertension Registry, treated with phosphodiesterase-5 inhibitors for ≥90 days, who were not at a pre-specified treatment goal, i.e. in World Health Organisation functional class III, with 6-min walking distance 165–440 m, and N-terminal prohormone of brain natriuretic peptide >300 ng/L. Changes in World Health Organisation functional class, 6-min walking distance, N-terminal prohormone of brain natriuretic peptide, and risk group between index and follow-up were assessed. Of patients with complete follow-up data, ( n = 53) 77% were on combination therapy and risk assessment yielded 98% at intermediate risk at index. At follow-up, 11 patients transitioned from World Health Organisation functional class III to World Health Organisation functional class II, the median (Q1; Q3) change in 6-min walking distance was 6 (−30; 42) meters and in N-terminal prohormone of brain natriuretic peptide 47 (−410; 603) ng/L, while 89% remained at an intermediate risk. Of those without complete follow-up data, 11 patients died and 2 underwent lung transplantation. In conclusion, pulmonary arterial hypertension patients treated with phosphodiesterase-5 inhibitors, as single or combination therapy and not achieving the pre-specified treatment goals after ≥90 days have an unfavourable clinical course. |
url |
https://doi.org/10.1177/2045894020958557 |
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