Medical treatment update on pulmonary arterial hypertension

Enderby, Cher Y.; Burger, Charles D.

doi:10.1177/2040622315590757

Cited by 23 publications

(23 citation statements)

References 31 publications

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“…The medications target 3 major pathways: nitric oxide enhancement, endothelin-1 blockade, or prostacyclin analog or receptor agonist; therefore, the drugs may be used as monotherapy or in combination. 11 , 13 , 14 Indeed, increasing evidence seems to indicate improved outcomes with combination therapy, either sequentially or as first-line treatment. 3 , 6 , 7 , 15 – 18 …”

Section: Resultsmentioning

confidence: 99%

Early intervention in the management of pulmonary arterial hypertension: clinical and economic outcomes

Burger¹,

Ghandour²,

Menon

et al. 2017

CEOR

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Pulmonary arterial hypertension (PAH) has a high morbidity rate and is fatal if left untreated. Increasing evidence supports early intervention, possibly with initial combination therapy. PAH-specific pharmaceuticals, however, are expensive and may have serious adverse effects, particularly when used in combination. The currently dynamic health care economy reinforces the need for a review of early intervention from both outcomes and economic perspectives. We aimed to review the clinical and economic impact of PAH therapy, particularly examining drug cost, hospitalization burden, and health care economics impact, and the effect of early intervention on clinical outcomes. We searched PubMed, Scopus, Ovid, and MEDLINE databases from 2005 to 2017 for studies comparing drug cost, clinical outcomes, and hospitalization burden associated with therapy for PAH. Emerging data indicate that early therapy is effective, but drug therapy is expensive, particularly with combination therapy. Efficacy studies also generally show benefit of combination therapy for patients in World Health Organization functional class II, with a consistent decrease in hospitalization. Pharmacoeconomic studies are limited but indicate that increased pharmacy costs are at least partially offset by decreased health care utilization, particularly inpatient care. Modeling also shows a cost benefit with combination therapy at 2 years. Nonetheless, more rigorously collected health care economic data should be incorporated into future drug efficacy trials to provide a clearer understanding of the impact and the associated cost benefit of early PAH therapy. Increasing evidence in support of early intervention and combination therapy for PAH is associated with rising medication costs that are largely offset by reduced hospitalization, on the basis of the currently available literature. Nonetheless, the studies performed to date have methodologic limitations that highlight the need for prospective studies using more robust economic modeling.

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Section: Resultsmentioning

confidence: 99%

Early intervention in the management of pulmonary arterial hypertension: clinical and economic outcomes

Burger¹,

Ghandour²,

Menon

et al. 2017

CEOR

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“…Management of group 1 PAH has included the use of prostanoids, endothelin receptor antagonists, and phosphodiesterase-5 inhibitors that target the prostacyclin receptor, endothelin-1 receptor, and nitric oxide signaling pathway. [1][2][3][4] During recent years, riociguat, a soluble guanylate cyclase stimulator, and selexipeg, a first-in-class, orally available, selective, non-prostanoid prostacyclin receptor (IP) agonist, have been used in the treatment of PAH. 5,6 The aforementioned pharmacotherapeutic agents have resulted in improved prognosis and quality of life but have also increased the complexity of decision making in treatment.…”

Section: Introductionmentioning

confidence: 99%

Treatment of Pulmonary Arterial Hypertension Using Initial Combination Therapy of Bosentan and Iloprost

et al. 2017

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“…The standard treatment options include oral anticoagulants, diuretics, oxygen supplementation, and calcium channel blockers. Targeted treatments such as prostacyclin analogs, endothelin receptor antagonists, and phosphodiesterase type 5 inhibitors, 4 , 5 which mainly address the increased vascular tone, lack the ability to reverse pulmonary vascular remodeling. As the impact of targeted therapies on the secondary forms of PH is uncertain, 6 , 7 , 8 the search for new therapeutic drugs is an urgent need.…”

Section: Introductionmentioning

confidence: 99%

Are statins beneficial for the treatment of pulmonary hypertension?

Wang

Yang

Wang

2017

Chronic Diseases and Translational Medicine

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Pulmonary hypertension (PH) is a condition characterized by vasoconstriction and vascular remodeling with a poor prognosis. The current medical treatments available are supportive care therapy and pulmonary vascular-targeted therapy. Targeted treatments for PH include prostacyclin analogs, endothelin receptor antagonists, and phosphodiesterase type 5 inhibitors; however, these treatments cannot reverse pulmonary vascular remodeling. Recently, many novel treatment options involving drugs such as statins have been emerging. In this review, we attempt to summarize the current knowledge of the role of statins in PH treatment and their potential clinical effects. Many basic researches have proved that statins can be helpful for the treatment of PH both in vitro and in experimental models. The main mechanisms underlying the effects of statins are restoration of endothelial function, attenuation of pulmonary vascular remodeling, regulation of gene expression, regulation of intracellular signaling processes involved in PH, anti-inflammatory responses, and synergy with other targeted drugs. Nevertheless, clinical researches, especially randomized controlled trials for PH are rare. The current clinical researches show contrasting results on the clinical effects of statins in patients with PH. Carefully designed randomized, controlled trials are needed to test the safety and efficacy of statins for PH treatment.

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Medical treatment update on pulmonary arterial hypertension

Cited by 23 publications

References 31 publications

Early intervention in the management of pulmonary arterial hypertension: clinical and economic outcomes

Early intervention in the management of pulmonary arterial hypertension: clinical and economic outcomes

Treatment of Pulmonary Arterial Hypertension Using Initial Combination Therapy of Bosentan and Iloprost

Are statins beneficial for the treatment of pulmonary hypertension?

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