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Transition from Bosentan to Ambrisentan in Pulmonary Arterial Hypertension: A Single-Center Prospective Study
Jingyuan Chen1, Jun Luo1, Xiaojie Yang1
1Department of Cardiovascular Medicine, Second Xiangya Hospital, Central South University, Changsha City, Hunan Province, People's Republic of China.
Insights
Stable pulmonary arterial hypertension (PAH) patients can safely transition from bosentan to ambrisentan. This drug switch did not negatively impact patient health, exercise capacity, or quality of life.
Area of Science:
- Cardiology
- Pulmonary Medicine
- Pharmacology
Background:
- Pulmonary arterial hypertension (PAH) poses a significant financial burden on patients due to high treatment costs and frequent hospitalizations.
- Endothelin receptor antagonists (ERAs) are crucial for PAH management, but their high cost presents a challenge.
- A transition from bosentan to ambrisentan, a more affordable ERA covered by Chinese medical insurance, is occurring in PAH treatment.
Purpose of the Study:
- To evaluate the safety, efficacy, and tolerability of ambrisentan in stable PAH patients following a transition from bosentan.
- To assess the impact of this drug transition on key clinical and functional parameters in PAH patients.
Main Methods:
- A cohort of 49 stable PAH patients transitioning from bosentan to ambrisentan was studied.
- Safety was monitored via liver and renal function tests at baseline and at 1, 3, and 6 months.
- Efficacy and tolerability were assessed using N-terminal pro-brain natriuretic peptide (NT-proBNP), echocardiography, WHO functional class (WHO-FC), 6-minute walking distance (6MWD), and quality of life (QOL) scales at baseline and 6 months.
Main Results:
- No significant differences were observed in 6-minute walking distance (6MWD), NT-proBNP, WHO functional class (WHO-FC), or QOL scores between baseline and 6 months post-transition.
- Liver and renal functions remained stable throughout the study period.
- Echocardiography showed a decrease in left ventricular end-diastolic dimension (LVEDD) at 6 months, with other parameters remaining unchanged.
Conclusions:
- Transitioning stable PAH patients from bosentan to ambrisentan is safe and well-tolerated.
- The switch to ambrisentan does not adversely affect hematologic parameters, heart function, exercise capacity, or quality of life.
- Ambrisentan offers a viable and safe alternative for PAH management, particularly where cost and insurance coverage are considerations.
Background:
Pulmonary hypertension patients experienced a high financial burden due to the high cost of drug therapy, high incidence of comorbidities and hospitalizations. Endothelin receptor antagonists (ERAs) in PAH treatment showed a high cost. While ambrisentan has been covered by medical insurance of a local government of China, there has been a drug transition from bosentan to ambrisentan in treating PAH patients. We evaluated the safety, efficacy and tolerability of ambrisentan after drug transition.
Methods:
Liver and renal functions were inspected at baseline, month 1, 3 and 6. NT-proBNP, echocardiographic variables, WHO functional class (WHO-FC), 6-minute walking distance (6MWD) were measured in the baseline and month 6 to evaluate the safety and efficacy. Quality of life (QOL) scale was used in the baseline and month 6 to investigate the tolerability and quality of life of PAH patients.
Results:
Among 224 PAH patients, 49 stable PAH patients meet the inclusion criteria were enrolled, among which three patients discontinued during the study. Our results showed no difference in 6-minute walking distance (6MWD) of PAH patients from baseline and month 6. The liver and renal function, N-terminal pro-brain natriuretic peptide (NT-proBNP), WHO functional class (WHO-FC) showed no difference either. For echocardiography parameters, the left ventricular end-diastolic dimension (LVEDD) of month 6 decreased. Other parameters were no significant difference from the baseline. There was no difference in the QOL scale between baseline and month 6.
Conclusion:
Our results suggested that it is safe and tolerable for stable PAH patients to transition from bosentan to ambrisentan without influencing hematologic parameters or heart function.
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