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Bosentan for chronic thromboembolic pulmonary hypertension: findings from a systematic review and meta-analysis

Cecilia Becattini1, Giorgia Manina, Chiara Busti

  • 1Internal and Cardiovascular Medicine, Department of Internal Medicine, University of Perugia, Perugia, Italy. cecilia.becattini@unipg.it

Thrombosis Research
|February 23, 2010
PubMed

Insights

Bosentan therapy improves exercise capacity and hemodynamics in patients with chronic thromboembolic pulmonary hypertension (CTEPH). Further research is needed to confirm effects on mortality and clinical worsening.

Area of Science:

  • Cardiology
  • Pulmonology
  • Pharmacology

Background:

  • Chronic thromboembolic pulmonary hypertension (CTEPH) affects approximately 1% of patients post-acute pulmonary embolism.
  • Bosentan is a potential therapeutic agent for managing CTEPH.

Purpose of the Study:

  • To systematically review and meta-analyze the effects of bosentan therapy in patients diagnosed with CTEPH.
  • To assess the impact of bosentan on exercise capacity, functional class, hemodynamics, mortality, and safety in CTEPH patients.

Main Methods:

  • Systematic literature search of MEDLINE and Embase databases using keywords 'pulmonary hypertension' and 'bosentan'.
  • Inclusion criteria: studies reporting on patients with objectively confirmed CTEPH treated with bosentan.
  • Efficacy measures included NYHA class, 6-minute walking distance (6MWD), cardiac index, pulmonary artery pressure, and pulmonary vascular resistance; mortality and safety were also evaluated.

Main Results:

  • Analysis included 11 studies (175 patients), comprising cohort studies, a randomized trial, and case reports.
  • Bosentan treatment led to a significant increase in 6MWD (35.9 meters at 3-6 months) and functional class improvement in approximately 25% of patients.
  • Hemodynamic improvements observed included increased cardiac index (0.23 L/min/m²) and decreased pulmonary artery pressure (2.62 mmHg) at 3-6 months, with low short-term mortality (1.4%).

Conclusions:

  • Bosentan therapy demonstrates potential benefits in improving hemodynamics and exercise capacity for CTEPH patients.
  • Further controlled studies are required to definitively establish the effects of bosentan on mortality and time to clinical worsening in CTEPH.
Abstract

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