Estimuladores de Guanilato Ciclase Solúvel (Riociguate) na Hipertensão Pulmonar: Dados da Prática Clínica Real em 3 Anos de Acompanhamento

Abstract

Resumo Fundamento A hipertensão pulmonar (HP) é uma doença rara e complexa com prognóstico ruim, que exige tratamento pela vida toda. Objetivo Descrever dados de 3 anos de acompanhamento da vida real sobre o tratamento com estimuladores de guanilato ciclase solúvel (Riociguate) de pacientes com HP, medindo parâmetros atuais de avaliação de risco. Métodos Coletamos dados clínicos e epidemiológicos retrospectivamente de pacientes com HP do grupo 1 (hipertensão arterial pulmonar) e do grupo 4 (HP tromboembólica crônica). Parâmetros não invasivos e invasivos correspondentes à avaliação de risco foram analisados na linha de base e no acompanhamento. Foram realizadas análises estatísticas usando o software SPSS 18.0, e os p-valores <0,050 foram considerados estatisticamente significativos. Resultados No total, 41 pacientes tratados com riociguate foram incluídos no estudo. Entre eles, 31 já concluíram 3 anos de tratamento e foram selecionados para a seguinte análise. Na linha de base, 70,7% dos pacientes estavam nas classes funcionais III ou IV da OMS. Depois de 3 anos de tratamento, a classe funcional da OMS melhorou significativamente em todos os pacientes. Além disso, a mediana do teste de caminhada de 6 minutos (TC6M) aumentou significativamente de 394 ± 91 m na linha de base para 458 ± 100 m após 3 anos de acompanhamento (p= 0,014). O índice de sobrevida após três anos foi de 96,7%. Conclusão Em nossa coorte de vida real, a maioria dos pacientes com HP tratados com riociguate demonstraram parâmetros de risco estáveis ou melhores, especialmente no TC6M, aos 3 anos de acompanhamento.

Riociguate: Uma Alternativa para Tratar a Hipertensão Pulmonar

“…Previously, Ghofrani et al 7 demonstrated that riociguat, through the direct activation of GCs, promoted an increase in cyclic GMP and consequently pulmonary vasodilation, and its administration 3 times daily in patients with PAH improved serum N terminal pro B type natriuretic peptide (NT-proBNP) concentrations, time to clinical worsening, and WHO functional class. 7 Reduction of NT-proBNP levels was not observed by Spilimbergo et al, 6 possibly explained by the small number of patients included in the study. Similarly, in 2015, the CHEST-2 study described that long-term administration of riociguat in patients with CTEPH improved exercise and functional capacity.…”

“…Thus, it is essential to search for pulmonary vasodilators that interfere with this relevant molecular pathways. 5 In issue of the Arquivos Brasileiros de Cardiologia, Spilimbergo et al 6 report a follow-up study in which patients with PH were treated with an GCs stimulant, riociguat, which is approved for treating PAH because it augments the nitric oxide (NO)-cyclic GMP pathway. The authors describe live cases outcome spanning 3 years, focusing on PAH (type 1) and chronic thromboembolic PH (CTEPH, type 4).…”

Devemos Considerar a Estimulação da Guanilil Ciclase Solúvel como Benéfica para o Tratamento da Hipertensão Pulmonar Pré-Capilar?

“…12 This biomolecular signaling is mainly explained by the opening of mitochondrial K ATP channels in cardiac cells. 12 In their groundbreaking paper of 2022, Spilimbergo et al 13 were the first researchers to retrospectively investigate the effects of riociguat in patients with PAH and CTEPH through a 3-year follow-up real-life study. 13 These scientists measured current risk assessment parameters and found interesting data which may help to prove the beneficial effects of riociguat in PAH and CTEPH subjects.…”

“…12 In their groundbreaking paper of 2022, Spilimbergo et al 13 were the first researchers to retrospectively investigate the effects of riociguat in patients with PAH and CTEPH through a 3-year follow-up real-life study. 13 These scientists measured current risk assessment parameters and found interesting data which may help to prove the beneficial effects of riociguat in PAH and CTEPH subjects. 13 Firstly, they have shown that riociguat significantly increased the 6-minute walking distance (6MWD) after at least 3 years of therapy, compared with the baseline data, in both patients with PAH and CTEPH.…”

“…13 These scientists measured current risk assessment parameters and found interesting data which may help to prove the beneficial effects of riociguat in PAH and CTEPH subjects. 13 Firstly, they have shown that riociguat significantly increased the 6-minute walking distance (6MWD) after at least 3 years of therapy, compared with the baseline data, in both patients with PAH and CTEPH. 13 The authors also found a gradual increase DOI: https://doi.org/10.36660/abc.20220261…”