Bosentan therapy for pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension: A systemic review and meta‐analysis

Chen, Xinwang; Zhai, Zhenguo; Huang, Ke; Xie, Wanmu; Wan, Jun; Wang, Chen

doi:10.1111/crj.12774

Cited by 24 publications

(22 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Firstly, for bosentan, one meta-analysis including 10 RCTs showed that bosentan reduced mPAP by 5.7 mmHg, increased CI by 0.4 L/minute/m 2 , and reduced PVR by 305.1 dyne s/cm 5 as compared with placebo. 13) Secondly, for ambrisentan, the result of the ATHENA-1 trial which evaluated the safety and efficacy of sequential add-on therapy of ambrisentan to 33 PAH patients who remained symptomatic despite background phosphodiesterase 5inhibitor (PDE5-I) monotherapy, indicated that ambrisentan achieved significant improvements in mPAP, CI, and PVR, the mean changes of which from baseline were −5.4 mmHg, +0.58 L/minute/m 2 , and −249 dyne s/cm 5 , respectively, after 6 months. 14) Thirdly, for macitentan, the results of the SERAPHIN hemodynamic substudy, which evaluated the hemodynamic efficacy of macitentan as compared with placebo in PAH patients, demonstrated that macitentan 10 mg achieved significant improvement of mPAP, CI, and PVR in 57 PAH patients after 6 months, the mean changes of which from baseline were −5.3 mmHg, +0.3 L/minute/m 2 , and −274 dyne s/cm 5 , respec- tively, and mean treatment effects of which as compared with placebo were −6.4 mmHg, +0.63 L/minute/m 2 , and −416 dyne s/cm 5 , respectively.…”

Section: Discussionmentioning

confidence: 99%

The Clinical Efficacy of Endothelin Receptor Antagonists in Patients with Pulmonary Arterial Hypertension

et al. 2020

View full text Add to dashboard Cite

Therapeutic strategies for pulmonary arterial hypertension (PAH) have made remarkable progress over the last two decades. Currently, 3 types of drugs can be used to treat PAH; prostacyclins, phosphodiesterase 5 inhibitors, and endothelin receptor antagonists (ERA). In Japan, the first generation ERA bosentan was reimbursed in 2005, following which the 2nd generation ERAs ambrisentan and macitentan were reimbursed in 2009 and 2015, respectively. The efficacy of each ERA on hemodynamics in PAH patients remains to be elucidated. The aims of this study were to evaluate the hemodynamic effects of ERAs and compare these effects among each generation of ERAs. We retrospectively examined the clinical parameters of 42 PAH patients who were prescribed an ERA (15 bosentan, 12 ambrisentan, and 15 macitentan) and who underwent a hemodynamic examination before and after ERA introduction at our institution from January 2007 to July 2019. In a total of 42 patients, mean pulmonary arterial pressure (mPAP) and pulmonary vascular resistance (PVR) were significantly decreased and cardiac index was significantly increased after ERA introduction (P < 0.001) and the World Health Organization-Functional class (WHO-Fc) was significantly improved after ERA introduction (P = 0.005). Next, in a comparison between 1st and 2nd generation ERAs, 2nd generation ERAs were found to have brought about greater improvements in hemodynamic parameters (mPAP and PVR. P < 0.01), heart rate, brain natriuretic peptide, arterial oxygen saturation, and mixed venous oxygen saturation than the 1st generation ERA bosentan. We conclude that all ERAs could successfully improve the hemodynamics of PAH patients and that the newer generation ERAs, ambrisentan and macitentan, seemed to be preferable to bosentan.

show abstract

Section: Discussionmentioning

confidence: 99%

The Clinical Efficacy of Endothelin Receptor Antagonists in Patients with Pulmonary Arterial Hypertension

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Although PDE5i and ETRA demonstrated haemodynamic improvement in CTEPH, 34 some patients did not achieve satisfactory management, whereas others developed side effects. 35,36 Although riociguat is the only therapy approved by the Food and Drug Administration for CTEPH, it has not yet been approved in China. As a result, PDE5i and ETRA are still used in the clinic.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary thromboendarterectomy is a curative resolution for chronic thromboembolic pulmonary hypertension associated with antiphospholipid syndrome: a retrospective cohort study

Liu

Song

et al. 2018

Lupus

View full text Add to dashboard Cite

Background Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare and life-threatening condition with poor prognosis in patients with antiphospholipid syndrome (APS). Pulmonary thromboendarterectomy (PTE) is the optimal surgical option for CTEPH. Objectives This retrospective cohort study aimed to evaluate the efficacy and risk of PTE in patients with APS-associated CTEPH. Methods Consecutive patients with APS-associated CTEPH diagnosed between January 2012 and September 2017 at Peking Union Medical College Hospital were retrospectively evaluated. Demographics, clinical manifestations, antiphospholipid antibody (aPL) profiles, and pulmonary arterial hypertension–targeted medications were collected. Deterioration of cardiac function and death were chosen as the endpoints, in order to assess the effect of PTE on short-term and long-term prognoses (evaluated by the change of cardiac function after treatment and cardiac deterioration or death in the follow-up, respectively). Results A total of 20 patients with APS-associated CTEPH were enrolled, and eight patients underwent PTE. Chi-square test (p = 0.01) and Kaplan–Meier curves (log rank test, p = 0.04) showed that there were statistically significant differences in both short-term and long-term prognoses between patients with and without PTE. Conclusion These results provide strong evidence that PTE is a curative resolution in patients with APS-associated CTEPH. Following a full specialized and multidisciplinary risk-benefit evaluation to limit the risk of thrombosis or bleeding and to manage possible thrombocytopenia, PTE is at least a temporal curative resolution for CTEPH complicated with APS.

show abstract

“…It is an antagonist of both ET A and ET B , however, its affinity to ET A is approximately 100 times greater than for the ET B [6] . Bosentan is proven to reduce pulmonary arterial pressure and arterial vessels resistance, increase cardiac output and improve performance of patients with PAH [13] , [14] . Moreover, it has been reported that bosentan is effective in treatment of ARDS [15] , [16] .…”

Section: Endothelin Receptor Antagonistsmentioning

confidence: 99%

Pulmonary artery targeted therapy in treatment of COVID-19 related ARDS. Literature review

Puk

Nowacka

Smulewicz

et al. 2022

Biomedicine & Pharmacotherapy

View full text Add to dashboard Cite

Introduction The most grievous complication of the COVID-19 is the acute respiratory distress syndrome. A specific, rescue treatment for rapidly deteriorating patients should emerge to improve respiratory function and help patients to survive the most challenging period. Drugs used in targeted therapy of pulmonary arterial hypertension (PAH) appears to be suitable for this task and this article describes their potential for treatment of severe cases of COVID-19. Methods The authors reviewed the following databases for randomized controlled trials, reviews and meta-analyses published up to July 2020: Pubmed, Scopus, Google Scholar, Cochrane Database and ClinicalKey. The authors included every study contributory to the assessment of the potential of drugs used in targeted PAH therapy in treatment of COVID-19. Results Endothelin receptor antagonists, phosphodiesterase 5 inhibitors, riociguat and prostacyclin have proven ani-inflammatory effect and reduce pulmonary artery blood pressure, lung oedema and remodelling. Bosentan shows antiviral properties and sildenafil, as well as epoprostenol, inhibits apoptosis of lung epithelial cells. Among patients with lung lesions the decrease of pulmonary blood pressure can lead to increase of ventilation/perfusion mismatch and decrease of blood oxygenation. Conclusions Among all assessed drugs bosentan, sildenafil and epoprostenol appear to be most promising and a combination of these drugs should be considered due to synergism. The targeted PAH therapy in treatment of COVID-19 associated ARDS could be a useful tool saving lives of patients with severe SARS-CoV-2 infection, however, its introduction should be investigated and monitored very carefully as it can lead to transient deterioration of patient condition.

show abstract

Bosentan therapy for pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension: A systemic review and meta‐analysis

Abstract: Bosentan is effective in treating PAH, whereas it improves only certain hemodynamic parameters of CTEPH. Incidence of liver function abnormality is higher in bosentan treatment.

Cited by 24 publications

References 29 publications

The Clinical Efficacy of Endothelin Receptor Antagonists in Patients with Pulmonary Arterial Hypertension

The Clinical Efficacy of Endothelin Receptor Antagonists in Patients with Pulmonary Arterial Hypertension

Pulmonary thromboendarterectomy is a curative resolution for chronic thromboembolic pulmonary hypertension associated with antiphospholipid syndrome: a retrospective cohort study

Pulmonary artery targeted therapy in treatment of COVID-19 related ARDS. Literature review

Contact Info

Product

Resources

About