Iloprost for pulmonary vasodilator testing in idiopathic pulmonary arterial hypertension

Abstract

The aim of this study was to confirm the utility of aerosolised iloprost for identifying long-term responders to calcium channel blockers (CCBs) in patients with idiopathic pulmonary arterial hypertension (IPAH).While undergoing right heart catheterisation, 74 patients with IPAH sequentially received incremental infusions of adenosine and aerosolised iloprost. The effects of the two vasodilators on haemodynamic parameters were recorded. All acute responders identified by aerosolised iloprost were subsequently treated with high doses of a CCB and were re-evaluated after 12 months.Both adenosine and iloprost produced significant decreases in mean pulmonary arterial pressure and pulmonary vascular resistance, and significant increases in cardiac index. Adverse effects were experienced by 35 out of the 74 patients with adenosine, but by only two with iloprost. Aerosolised iloprost identified more acute responders than infused adenosine (10 versus eight, respectively) according to the criteria recommended in recent consensus guidelines. Nine responders identified by iloprost were followed-up after 12 months of high-dose CCB therapy. Five had normal or near-normal haemodynamics and a World Health Organization functional classification of I or II after 12 months.Aerosolised iloprost is an appropriate new agent to identify long-term responders to CCBs in patients with IPAH. It is as effective in this regard as infused adenosine but is better tolerated.

Pulmonary vasoreactivity testing with inhaled iloprost in children with pulmonary hypertension related to congenital heart disease

“…While non-inferiority was shown for both agents in terms of efficacy, the iloprost was found to be safer with regard to side effects. In fact, only two out of the 74 patients in the study had side effects (a cough and hypotension) that could be attributed to this agent, [17] and in our study, no adverse effects were associated with iloprost.…”

“…Thus, as an alternative to iNO, the use of inhaled iloprost has increased in recent years, [15,16] and many centers have started using it for vasoreactivity testing, particularly in adult patients. For example, a recent study by Jing et al [17] showed for the first time that aerosolized iloprost could be used for pulmonary vasoreactivity testing, and Opitz et al [18] found that inhaled iloprost demonstrates pulmonary selectivity in contrast to intravenous prostacyclin. In addition, it was found to be a more potent pulmonary vasodilator than iNO in studies conducted on adults.…”

“…However, there are only a limited number of relevant studies that have focused on the use of this agent in pediatric patients. [4,7,12,17] Iloprost is a selective, short-acting vasodilator and a prostacyclin analogue with a stable structure. It has a half-life of 20-30 minutes and is readily available in many countries.…”

Atorvastatin in Pulmonary Arterial Hypertension (APATH) study

“…Secondary end-points included: time from randomisation to clinical worsening (defined as death, the first occurrence of hospitalisation for PAH or initiation of PAH targeted therapy decided by an independent panel of physicians) and change from baseline to week 24 in World Health Organization (WHO) functional class (an adaptation of the New York Heart Association classification [24]), Borg dyspnoea score (with 0 representing no dyspnoea and 10 maximal dyspnoea [23]), and haemodynamic parameters (mean pulmonary artery pressure, right atrial pressure, cardiac output and pulmonary vascular resistance) derived from right heart catheterisation. Haemodynamic parameters were measured as described previously [25]. Cardiac output was determined using the thermodilution technique or calculated according to the Fick method.…”

Pulmonary vasoreactivity testing in diagnosis and prognosis of pulmonary hypertension

“…Diğer potansiyel pulmoner vazodilatör ajanlar İloprost inhalasyonu ve sildenafil gibi ajanlarla önemli boyutta pulmoner vazodilatör yanıt elde edilmiş olsa da PVT' de kullanımları için henüz yeterli klinik kanıt yoktur ve son güncel kıla-vuzlar henüz PVT için bu ajanları önermemektedir (1,2,20,29).…”