Inhaled iloprost in pulmonary arterial hypertension.

Area of Science:

• Pharmacology and clinical evaluation of inhaled iloprost.
• Pulmonary arterial hypertension (PAH) therapeutics.

Background:

• Pulmonary arterial hypertension (PAH) is a severe condition.
• Iloprost is a stable prostacyclin analog with vasodilatory and antiproliferative properties.

Purpose of the Study:

• To review the pharmacology, pharmacodynamics, and clinical trials of inhaled iloprost in PAH.
• Evaluate the efficacy and safety of inhaled iloprost for PAH treatment.

Main Methods:

• Systematic literature search of MEDLINE (1996-2005) using keywords: pulmonary hypertension, iloprost, epoprostenol.
• Inclusion of English-language clinical trials and review of article references.
• Data extraction on drug approval, clinical trial outcomes, and adverse events.

Main Results:

• Inhaled iloprost demonstrated significant improvement in New York Heart Association functional class and 6-minute walk distance in a placebo-controlled trial (n=203).
• Short-term trials showed hemodynamic benefits, both as monotherapy and in combination with other vasodilators.
• Positive attributes include aerosolized delivery and low adverse event incidence; limitations include administration frequency and lack of comparative data.

Conclusions:

• Inhaled iloprost presents a potential treatment option for specific PAH patient groups, including those with contraindications to bosentan or preference for non-parenteral routes.
• It may serve as adjunctive therapy with other pulmonary vasodilators.
• Larger, long-term clinical trials are essential to define its definitive role in PAH management.