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Related Experiment Videos

Prostacyclin for pulmonary hypertension.

N S Paramothayan1, T J Lasserson, A U Wells

  • 1Division of Physiological Medicine, St George's Hospital Medical School, Cranmer Terrace, London, UK, SW17 0RE.

The Cochrane Database of Systematic Reviews
|June 14, 2003
PubMed
Summary

Prostacyclin analogues improve exercise capacity and cardiopulmonary function in primary pulmonary hypertension patients over 12 weeks. Alternative administration routes show promise with fewer side effects than intravenous therapy.

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Area of Science:

  • Cardiology
  • Pulmonology
  • Pharmacology

Background:

  • Primary pulmonary hypertension (PPH) is a severe condition leading to right ventricular failure and poor survival.
  • PPH can be idiopathic or associated with conditions like scleroderma and CREST syndrome.
  • Prostacyclin is a vasodilator and platelet aggregation inhibitor; Iloprost is a stable analogue with similar effects.

Purpose of the Study:

  • To evaluate the efficacy of prostacyclin or its analogues in treating idiopathic primary pulmonary hypertension.

Main Methods:

  • Conducted a systematic review of randomized controlled trials (RCTs) from the Cochrane controlled clinical trial register.
  • Included RCTs involving patients with primary pulmonary hypertension or secondary pulmonary hypertension due to connective tissue disorders.

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  • Assessed study quality and extracted data independently; analyzed outcomes using standard statistical techniques.

    • Main Results:

    • Seven short-term RCTs (8-12 weeks) were analyzed, comparing various prostacyclin analogues (epoprostenol, iloprost, treprostinil) with conventional therapy or placebo.
    • All trials demonstrated improvements in exercise capacity; some showed benefits in cardiopulmonary hemodynamics, dyspnea, and symptoms.
    • Intravenous administration was associated with significant side effects like sepsis and thrombosis, whereas other routes had fewer adverse events.

    Conclusions:

    • Prostacyclin analogues, when added to conventional therapy for 12 weeks, appear to enhance exercise capacity, NYHA functional class, and cardiopulmonary hemodynamics in PPH patients.
    • Evidence suggests that alternative administration routes may offer comparable efficacy with a reduced side effect profile, particularly avoiding catheter-related complications.