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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. M...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2016
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4709958/ https://www.ncbi.nlm.nih.gov/pubmed/26753921 http://dx.doi.org/10.1186/s12890-015-0164-2 |
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author | Gall, Henning Sommer, Natascha Milger, Katrin Richter, Manuel J. Voswinckel, Robert Bandorski, Dirk Seeger, Werner Grimminger, Friedrich Ghofrani, Hossein-Ardeschir |
author_facet | Gall, Henning Sommer, Natascha Milger, Katrin Richter, Manuel J. Voswinckel, Robert Bandorski, Dirk Seeger, Werner Grimminger, Friedrich Ghofrani, Hossein-Ardeschir |
author_sort | Gall, Henning |
collection | PubMed |
description | 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12890-015-0164-2) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-4709958 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-47099582016-01-13 Survival with sildenafil and inhaled iloprost in a cohort with pulmonary hypertension: an observational study Gall, Henning Sommer, Natascha Milger, Katrin Richter, Manuel J. Voswinckel, Robert Bandorski, Dirk Seeger, Werner Grimminger, Friedrich Ghofrani, Hossein-Ardeschir BMC Pulm Med Research Article 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12890-015-0164-2) contains supplementary material, which is available to authorized users. BioMed Central 2016-01-12 /pmc/articles/PMC4709958/ /pubmed/26753921 http://dx.doi.org/10.1186/s12890-015-0164-2 Text en © Gall et al. 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Article Gall, Henning Sommer, Natascha Milger, Katrin Richter, Manuel J. Voswinckel, Robert Bandorski, Dirk Seeger, Werner Grimminger, Friedrich Ghofrani, Hossein-Ardeschir Survival with sildenafil and inhaled iloprost in a cohort with pulmonary hypertension: an observational study |
title | Survival with sildenafil and inhaled iloprost in a cohort with pulmonary hypertension: an observational study |
title_full | Survival with sildenafil and inhaled iloprost in a cohort with pulmonary hypertension: an observational study |
title_fullStr | Survival with sildenafil and inhaled iloprost in a cohort with pulmonary hypertension: an observational study |
title_full_unstemmed | Survival with sildenafil and inhaled iloprost in a cohort with pulmonary hypertension: an observational study |
title_short | Survival with sildenafil and inhaled iloprost in a cohort with pulmonary hypertension: an observational study |
title_sort | survival with sildenafil and inhaled iloprost in a cohort with pulmonary hypertension: an observational study |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4709958/ https://www.ncbi.nlm.nih.gov/pubmed/26753921 http://dx.doi.org/10.1186/s12890-015-0164-2 |
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