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Combination Therapy Improves Pulmonary Hypertension

Oral sildenafil added to long-term intravenous epoprostenol improves function in pulmonary hypertension

TUESDAY, Oct. 21 (HealthDay News) -- Among patients with pulmonary arterial hypertension, adding sildenafil to long-term intravenous epoprostenol therapy improves exercise capacity, hemodynamic measurements, time to clinical worsening and quality of life with a relatively small increase in side effects, researchers report in the Oct. 21 issue of the Annals of Internal Medicine.

Gerald Simonneau, M.D., of the Hopital Antoine Beclere in Clamart, France, and colleagues performed a multinational double-blind, placebo-controlled, parallel group study examining the effect of adding oral sildenafil to the treatment regimen of 265 patients with pulmonary arterial hypertension already treated with long-term intravenous epoprostenol. Patients were randomized to placebo or sildenafil and outcome measures were improvement in six-minute walk distance, hemodynamic measurements, time to clinical worsening and Borg dyspnea score.

The researchers report that 97 percent of the patients (133 in the sildenafil group and 123 in the placebo group) completed the study. Sildenafil treatment was associated with an increase of 28.8 meters in the six-minute walk distance and improvements in mean pulmonary arterial pressure, time to clinical worsening, and health-related quality of life compared to monotherapy, but not on the Borg dyspnea score.

"Taken together, these results indicate that sildenafil may be used in combination with epoprostenol as part of a multiple treatment regimen to improve exercise capacity in patients with pulmonary arterial hypertension without an apparent increase in adverse events, especially in stable patients with pulmonary arterial hypertension who remain symptomatic despite long-term intravenous epoprostenol treatment," the authors conclude.

The study was supported by Pfizer. Several of the study authors report financial relationships with the pharmaceutical industry.

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