シストリック左心室機能不全による肺高血圧の患者に対するリオシグアット:二次盲検,ランダム化,プラセボ対照,投与量の変動によるIIb相血液動力学的研究
Diana Bonderman1, Stefano Ghio, Stephan B Felix
1Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria.
Circulation
|June 19, 2013
まとめ
リオシグアットは,主評価値を満たしていないにもかかわらず,静脈左心房機能不全による肺高血圧の患者で心臓指数を改善し,血管抵抗を低下させた. 治療はよく耐えており,この状態の管理の可能性を示しています.
科学分野:
- 心臓病学 心臓病学
- 肺内医学 肺内医学 肺内医学
- 薬理学 薬理学とは
背景:
- シストリック左心室機能不全による肺高血圧は,承認された治療法がないと,健康に重大なリスクをもたらす.
- 溶性グアニラートサイクラゼ刺激剤は,心血管疾患に対する新しい治療法です.
研究 の 目的:
- シストリック左心室機能不全による肺高血圧の患者におけるリオシグアットの有効性と安全性を評価する.
- 肺動脈の平均血圧と心臓指数を含む血液動力学的パラメータに対するリオシグアットの影響を評価する.
主な方法:
- 201人の患者が参加したランダム化,ダブルブラインド,プラセボ対照試験です.
- 患者は,16週間にわたって1日3回経口プラセボまたはリオシグアット (0.5,1,または2mg) を投与されました.
- プライマリアウトカム:第16週における肺動脈平均圧のプラセボ調整による変化.
主要な成果:
- リオシグアート (2mg) は,心拍数や血圧に影響を及ぼさず,心拍数指数と脳卒中量指数を有意に増加させた.
- 肺および全身的血管抵抗は,リオシグアット2mgで有意に減少しました.
- ミネソタ州における"心不全で生きる"スコアはリオシグアットにより改善され,治療中止率はグループ間で類似した.
結論:
- Riociguatは,この患者集団において,改善された心指数および減少した血管抵抗を含む,好ましい血液動力学的効果を示した.
- プライマリエンドポイントは達成されなかったが,リオシグアートはよく耐えており,肺高血圧の心不全患者にとって潜在的な利点を示した.
- 更に,シストリック左心房機能不全に関連した肺高血圧の管理におけるリオシグアットの役割を調査する研究が進められる.
関連する概念動画
Treatment for Pulmonary Arterial Hypertension: Prostacyclin Receptor Agonists
Prostacyclin receptor agonists are a class of therapeutic agents integral to managing pulmonary arterial hypertension (PAH). These drugs operate by mimicking the action of prostaglandin I2, or PGI2, a naturally occurring compound in the body.
These agonists bind to the IPR receptor situated on the plasma membrane of the pulmonary artery smooth muscle cells. This binding triggers a cascade of reactions known as the GS-AC-cAMP-PKA pathway. This pathway results in the relaxation of smooth muscle...
These agonists bind to the IPR receptor situated on the plasma membrane of the pulmonary artery smooth muscle cells. This binding triggers a cascade of reactions known as the GS-AC-cAMP-PKA pathway. This pathway results in the relaxation of smooth muscle...
Treatment for Pulmonary Arterial Hypertension: Phosphodiesterase Inhibitors
Phosphodiesterase 5 (PDE5) inhibitors are potent enzymes that function to hydrolyze cyclic nucleotides to their corresponding 5' monophosphates. Their unique biochemical properties have been applied in treating Pulmonary Arterial Hypertension (PAH).
Among the PDE5 inhibitors, sildenafil (Revatio) stands out as a competitive and selective inhibitor. It operates by elevating cellular levels of cGMP and augmenting signaling through the cGMP-PKG pathway, promoting vasodilation. Upon oral...
Among the PDE5 inhibitors, sildenafil (Revatio) stands out as a competitive and selective inhibitor. It operates by elevating cellular levels of cGMP and augmenting signaling through the cGMP-PKG pathway, promoting vasodilation. Upon oral...
Treatment for Pulmonary Arterial Hypertension: Receptor Tyrosine Kinase Inhibitors and Calcium Channel Blockers
Receptor tyrosine kinase inhibitors (TKIs) and calcium channel blockers (CCBs) are two critical categories of drugs employed in the treatment of pulmonary artery hypertension (PAH). PAH is a disease that causes high blood pressure in the pulmonary arteries, resulting in chest pain, fatigue, and shortness of breath.
TKIs, such as imatinib (Gleevec), are particularly effective in tackling the growth and mitogenic factors that become upregulated in PAH patients. These factors contribute to the...
TKIs, such as imatinib (Gleevec), are particularly effective in tackling the growth and mitogenic factors that become upregulated in PAH patients. These factors contribute to the...
Treatment for Pulmonary Arterial Hypertension: Endothelin Receptor Antagonists
Endothelins (ETs) are potent vasoactive peptides critical in the human body's various physiological and pathological processes. One of the most promising therapeutic strategies for treating pulmonary arterial hypertension (PAH) involves counteracting the effects of these endothelins using a class of drugs known as endothelin receptor antagonists.
ETs are synthesized through a complex sequence of enzymatic steps, primarily involving an enzyme referred to as endothelin-converting enzyme (ECE). Of...
ETs are synthesized through a complex sequence of enzymatic steps, primarily involving an enzyme referred to as endothelin-converting enzyme (ECE). Of...
Pulmonary Hypertension: Classification and Pathogenesis
Pulmonary hypertension (PH) is a severe health condition in which the mean pulmonary arterial pressure increases to 25 mmHg or more, even when the body is at rest. This high pressure in the blood vessels that transport blood from the heart to the lungs can cause various symptoms, including shortness of breath, can lead to right heart failure, and significantly affect the overall quality of life.
There are various classifications for PH, each relating to different underlying causes and also...
There are various classifications for PH, each relating to different underlying causes and also...
Cardiac Catheterization II: Right Heart Catheterization
Right Heart Catheterization: An OverviewRight heart catheterization is an invasive diagnostic procedure that measures right-sided cardiac and pulmonary artery pressures, calculates cardiac output, and identifies intracardiac shunts. It provides detailed hemodynamic data essential for diagnosing and managing various cardiovascular conditions, such as pulmonary hypertension.Access SitesCommon access sites for right heart catheterization include the internal jugular vein in the neck region, the...

