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Long-term efficacy of bosentan in inoperable chronic thromboembolic pulmonary hypertension
M C Post1, H W M Plokker, J C Kelder
1Department of Cardiology, St Antonius Hospital, Nieuwegein, the Netherlands.
Insights
Long-term treatment with bosentan improves symptoms and functional capacity in patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH). This dual endothelin receptor antagonist demonstrates sustained efficacy and an 88% four-year survival rate in this challenging patient group.
Area of Science:
- Cardiology
- Pulmonology
- Pharmacology
Background:
- Inoperable chronic thromboembolic pulmonary hypertension (CTEPH) presents significant survival challenges.
- Early intervention is crucial for managing CTEPH progression and improving patient outcomes.
Purpose of the Study:
- To assess the long-term effectiveness of bosentan, a dual endothelin receptor antagonist, in patients with inoperable CTEPH.
- To evaluate the sustained impact of bosentan on functional capacity and clinical markers.
Main Methods:
- A cohort of 18 patients with symptomatic inoperable CTEPH received bosentan treatment.
- Efficacy was measured using N-terminal-pro brain natriuretic peptide (NT-pro BNP) levels, New York Heart Association (NYHA) functional class, and the six-minute walk test (6-MWT).
- Follow-up data were analyzed at short-term (<12 months), mid-term (12-24 months), and long-term (>24 months) intervals.
Main Results:
- Bosentan treatment led to significant improvements in NYHA class and 6-MWT distance during short-term and mid-term follow-up.
- While NT-pro BNP levels initially decreased, they remained stable during mid-term and long-term follow-up.
- Despite a slight decrease in 6-MWT distance in late follow-up, NYHA class remained improved, and the overall four-year survival rate was 88%.
Conclusions:
- Bosentan demonstrates sustained efficacy in managing inoperable CTEPH over the long term.
- The drug appears to be a valuable therapeutic option for improving functional status and survival in this patient population.
Unlabelled:
Background. Inoperable chronic thromboembolic pulmonary hypertension (CTEPH) is associated with a poor survival.Objectives. To evaluate the long-term response to a dual endothelin receptor antagonist in patients with inoperable CTEPH.Methods. All consecutive 18 patients (mean age 63+/-14 years) treated with bosentan for symptomatic inoperable CTEPH were included. Efficacy was evaluated by the log value of serum levels of N-terminal-pro brain natriuretic peptide (log NTpro BNP), New York Heart Association functional class (NYHA), and the six-minute walk test (6-MWT). All follow-up data (median 31 months) were compared with baseline and divided into: short-term (<12 months), mid-term (between 12 and 24 months), and long-term follow-up (>24 months).Results. At baseline, 15 patients were in NYHA class III and three in NYHA class IV, mean log NT-pro BNP level was 7.2+/-1.4 log pg/ml, and mean 6-MWT distance was 404+/-125 m. During short-term follow-up (n=18), the NYHA class improved (p=0.001), 6-MWT distance increased by 33 m (p=0.03), and log NT-pro BNP decreased to 6.9+/-1.4 log pg/ml (p=0.007). During mid-term follow-up (n=17), the NYHA class improved (p<0.001), the mean 6-MWT distance increased by 41 m (p=0.01), and log NT-pro BNP was 6.9+/-1.4 log pg/ml (p=0.31). During late followup (n=14) the NYHA class was still improved (p=0.03), the 6-MWT distance decreased by 9 m (p=0.73), and log NT-pro BNP was 7.1+/-1.5 log pg/ml (p=0.91). The overall four year survival rate was 88%.
Conclusion:
Bosentan seems to be effective during long-term treatment in patients with inoperable CTEPH. (Neth Heart J 2009;17:329-33.).
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