The effect of sildenafil on retinopathy of prematurity in very preterm infants

Fang, A Y W; Guy, Katelyn J.; König, Kai

doi:10.1038/jp.2012.84

Cited by 22 publications

(21 citation statements)

References 24 publications

(29 reference statements)

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“…52,53 Whereas case reports have linked sildenafil treatment with potentially enhanced ROP progression and severity, 53 subsequent retrospective crosssectional studies have found no adverse outcomes in premature infants with ROP who were treated with sildenafil for pulmonary hypertension. 54,55 Previous studies of the effects of PDE5 inhibitors in the eye have focused largely on retinal and choroidal blood flow, showing increased choroidal congestion and ophthalmic artery velocity and flow, with controversial results in the retinal vasculature. 56,57 Using ex vivo human retinal tissue to study the distribution of PDE5, researchers have shown that in addition to retinal and choroidal vasculature, PDE5 was expressed in retinal ganglion and bipolar cells.…”

Section: Existing Data For Retinal Side Effects Of Sildenafil In Humamentioning

confidence: 99%

Sildenafil Attenuates Vaso-Obliteration and Neovascularization in a Mouse Model of Retinopathy of Prematurity

Fawzi

Chou

Kim

et al. 2014

Invest. Ophthalmol. Vis. Sci.

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Sildenafil treatment significantly decreased retinal vaso-obliteration and neovascularization in a mouse OIR model. These effects are likely due to sildenafil-induced HIF1α stabilization during hyperoxia exposure. Furthermore, we confirm disease overlap by showing that OIR mice also develop hyperoxia-induced right ventricular hypertrophy, which is prevented by sildenafil. This study is a first step toward delineating a potential therapeutic role for sildenafil in OIR and further suggests that there may be common pathophysiologic mechanisms underlying hyperoxia-induced retinal and pulmonary vascular disease.

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Section: Existing Data For Retinal Side Effects Of Sildenafil In Humamentioning

confidence: 99%

Sildenafil Attenuates Vaso-Obliteration and Neovascularization in a Mouse Model of Retinopathy of Prematurity

Fawzi

Chou

Kim

et al. 2014

Invest. Ophthalmol. Vis. Sci.

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“…It is also an attractive therapeutic option for infants with pulmonary hypertension caused by BPD because it can be given orally, and over longer periods of time with apparent low toxicity. Several case series of infants with pulmonary hypertension and BPD have shown short-term improvements in pulmonary hemodynamics and gas exchange in those treated with oral sildenafil 78, 79 . These early studies suggest that sildenafil is well tolerated in infants with pulmonary hypertension and BPD and leads the way to future RCTs evaluating sildenafil in pulmonary hypertension associated with BPD.…”

Section: Introductionmentioning

confidence: 99%

An update on pharmacologic approaches to bronchopulmonary dysplasia

Ghanta

Leeman

Christou

2013

Seminars in Perinatology

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Bronchopulmonary dysplasia (BPD) is the most prevalent long-term morbidity in surviving extremely preterm infants and is linked to increased risk of reactive airways disease, pulmonary hypertension, post-neonatal mortality, and adverse neurodevelopmental outcomes. BPD affects approximately 20% of premature newborns, and up to 60% of premature infants born before 26 completed weeks of gestation. It is characterized by the need for assisted ventilation and/or supplemental oxygen at 36 weeks’ postmenstrual age. Approaches to prevention and treatment of BPD have evolved with improved understanding of its pathogenesis. This review will focus on recent advancements and detail current research in pharmacotherapy for BPD. The evidence for both current and potential future experimental therapies will be reviewed in detail. As our understanding of the complex and multifactorial pathophysiology of BPD changes, research into these current and future approaches must continue to evolve.

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“…No abnormal auditory or ophthalmologic exams were noted at the time of discharge. Steiner et al (2014) 36 AE with sildenafi l: pulmonary hemorrhage (2/6 patients, at a time point when signifi cant improvement of PH had already taken place; both survived) Fang et al (2013) 39 AE: Stage 3 ROP, 4 (23.5%) in sildenafi l group, 6 (11.8%) in controls; progression of ROP, 5(29%) in sildenafi l group, 12 (24%) in controls; OR (sildenafi l) = 1.35, 95% CI, 0.39-4.62; P = .63. SAE: 1 infant in each group required laser treatment.…”

Section: Are Pde5 Inhibitors Effective In Improving Clinical Outcomesmentioning

confidence: 99%

“…41,42 One study that reviewed the ophthalmologic adverse effects of sildenafil in very premature infants reported that treatment did not affect retinopathy of prematurity (ROP) progression or need for laser treatment (P = .63) ( Table 4, Supplemental Table 20). 39 The evidence is insufficient to allow definitive statements about the toxicities of sildenafil due to the small number of studies with inconsistent results.…”

Section: What Toxicities Are Associated With Use Of Pde5 Inhibitors Imentioning

confidence: 99%

Pulmonary Hypertension Therapy and a Systematic Review of Efficacy and Safety of PDE-5 Inhibitors

Unegbu¹,

Noje²,

Coulson

et al. 2017

Pediatrics

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Pulmonary hypertension (PH) is a syndrome that is of growing concern to pediatricians worldwide. Recent data led to concerns about the safety of phosphodiesterase type 5 (PDE5) inhibitors in children and a US Food and Drug Administration safety advisory. Our objective is to provide insight into therapies for PH in children and to systematically review the comparative effectiveness and safety of PDE5 inhibitors in the management of pediatric patients with PH. We searched the following databases through February 2015: Medline, Embase, SCOPUS, and the Cochrane Central Register of Controlled Trials. We included studies that examined PDE5 inhibitor use in children with PH. Allowed comparators were either no medication or other classes of medication for management of PH. Study inclusion was via a 2-stage process with 2 reviewers and a predesigned form. Of 1270 papers identified by the literature search, 21 were included: 8 randomized controlled trials and 13 observational studies (9 retrospective, 4 prospective). There is strong evidence that PDE5 inhibitor use improves echocardiography measurements, cardiac catheterization parameters, and oxygenation compared with baseline or placebo in pediatric patients with PH. Evidence suggests that low- and moderate-dose sildenafil are safe regimens for children. There are a relatively small number of randomized controlled trials that address use of PDE5 inhibitors in pediatric patients with PH. PDE5 inhibitors are effective agents for cardiovascular and oxygenation end points in pediatric PH and important components of a multimodal pharmacotherapeutic approach to this growing challenge. Additional studies are needed to define optimal PH therapy in childhood.

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The effect of sildenafil on retinopathy of prematurity in very preterm infants

Abstract: Sildenafil treatment did not affect ROP progression or increase the need for laser treatment in this cohort.

Cited by 22 publications

References 24 publications

Sildenafil Attenuates Vaso-Obliteration and Neovascularization in a Mouse Model of Retinopathy of Prematurity

Sildenafil Attenuates Vaso-Obliteration and Neovascularization in a Mouse Model of Retinopathy of Prematurity

An update on pharmacologic approaches to bronchopulmonary dysplasia

Pulmonary Hypertension Therapy and a Systematic Review of Efficacy and Safety of PDE-5 Inhibitors

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