Erfolgreiche Umstellung einer intravenösen Langzeittherapie mit Iloprost auf eine nicht invasive Kombinationstherapie bei idiopathischer pulmonal arterieller Hypertonie

Abstract

In Europe intravenous (IV) iloprost, an alternative to epoprostenol, is an accepted treatment option for severely compromised patients with idiopathic pulmonary arterial hypertension (IPAH). Once initiated, this therapy usually has to be continued lifelong or as bridging to transplantation. In our paper we describe two patients with IPAH in World Health Organisation (WHO) functional classes II and III while on treatment with continuous IV iloprost monotherapy or combination therapy with continuous IV iloprost plus oral bosentan, respectively. The duration of IV iloprost therapy was 4.5 and 2.5 years, respectively. Because of life-threatening or recurring catheter-related complications during long-term IV iloprost therapy, these patients were switched to non-invasive combination therapy consisting of oral bosentan plus aerosolized iloprost (patient 1) and oral bosentan plus aerosolized iloprost plus oral sildenafil (patient 2), respectively. After four weeks of additional bosentan therapy, stepwise reduction and discontinuation of IV iloprost were performed within eight hours in the patient in WHO class II, and within five days in the patient in WHO class III. Simultaneously, therapy with aerosolized iloprost was started in the first patient and with aerosolized iloprost plus sildenafil in the second patient. Both patients were safely switched from IV iloprost to non-invasive combination therapy while WHO classification of functional status remained unchanged for at least 12 and 14 months, respectively. These data suggest that selected patients with complications due to IV iloprost treatment can be safely switched to non-IV combination therapies.

Addition of Sildenafil to Long-Term Intravenous Epoprostenol Therapy in Patients with Pulmonary Arterial Hypertension

“…Therefore, combination therapies using drugs with different mechanisms of action expected to have additive or synergistic effects have been considered (9 -11). (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23). Two randomized, placebo-controlled trials have been published (17,23).…”

Dual therapy in IPAH and SSc-PAH. A qualitative systematic review

“…65 This strategy has also been shown to be less expensive. 66 Thus, the aims of dual oral therapy are to prevent patients from receiving invasive continuous prostaglandin analogues, wean off prostaglandin analogues or delay lung transplantation.…”