Nitrogen oxide biochemical pathway in pulmonary arterial hypertension therapy and REPLACE trial results

Шмальц, А.А.; Алексеевич, Шмальц Антон; Горбачевский, С.В.; Валерьевич, Горбачевский Сергей

doi:10.26442/2075-082x_2018.2.72-76

Cited by 2 publications

(1 citation statement)

References 35 publications

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“…Стратегической целью лечения больных ЛГ согласно российским, евразийским и европейским рекомендациям является достижение и длительное сохранение статуса низкого риска [2-6, [31][32][33][34][35]. При этом традиционный подход к повышению эффективности специфической терапии при прогрессировании легочной сосудистой болезни -добавление новых препаратов с сохранением предыдущих (так называемая последовательная комбинированная терапия)в наши дни пересматривается [31,[34][35][36][37][38][39].…”

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Optimization of specific therapy for pulmonary hypertension: the possibilities of riociguat

Martynyuk

Витальевна²,

Шмальц

et al. 2021

Terapevticheskii arkhiv

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Pulmonary hypertension (PH) is a severe and often rapidly progressive disease with fatal outcome. Endothelial dysfunction in PH is associated with decreased nitric oxide production. After reviewing the mechanisms of action and the evidence base for specific therapy with phosphodiesterase 5 inhibitors (PDE-5) and soluble guanylate cyclase stimulators, a reseach review on switching from PDE-5 to riociguat is conducted. A potential advantage of riociguat is its independence from endogenous nitric oxide and from the other (besides PDE-5) isoenzymes of phosphodiesterases. The favorable efficacy profile of sildenafil has been proven for the main forms of pulmonary arterial hypertension, of riociguat for the main forms of pulmonary arterial hypertension and chronic thromboembolic PH. The clinical efficacy of replacing PDE-5 with riociguat has been demonstrated in uncontrolled trials and in the randomized controlled study REPLACE. The possibility of therapy optimization by switching from IFDE-5 to riociguat is fixed in the Russian (class and level of evidence B-3) and Eurasian (class and level of evidence IIb-B) clinical guidelines, as well as in the materials of the Cologne Expert Consensus. An additional argument for switching is the lower cost as compared to combination therapy in the Russian Federation. According to the Russian and Eurasian guidelines for PH and the Russian instructions for the use of riociguat, the drug should be taken at least 24 hours after sildenafil discontinuation.

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Optimization of specific therapy for pulmonary hypertension: the possibilities of riociguat

Martynyuk

Витальевна²,

Шмальц

et al. 2021

Terapevticheskii arkhiv

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Soluble Guanylate Cyclase Stimulators for Chronic Thromboembolic Pulmonary Hypertension Patients Treatment: New Data

Симакова

Моисеева

2020

Racionalʹnaâ farmakoterapiâ v kardiologii

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This narrative review describes and appraises some relatively new studies investigating the efficacy and safety profile of soluble guanylate cyclase stimulator riociguat in patients suffering from pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH). It has been a while since the publication date of pivotal CHEST-1 trial in 2013. New studies available complement existing evidence, expound on specific questions and open new frontiers for CTEPH investigations going forward. In this paper authors attempted to present data from post-hocanalysis of the CHEST-1 study and real-world data on riociguat treatment, confirming the positive effect of the drug on hemodynamic parameters of the pulmonary circulation and the functional status of patients. This effect was shown previously in large randomized trials. The extremely important positive effect of riociguat demonstrated both in the group of inoperable patients with CTEPH and in patients with residual pulmonary hypertension after pulmonary thrombendarterectomy. Of great interest are the presented some authors results of reverse remodelling of the right heart chambers during riociguat therapy in CTEPH patients, including using unique imaging methods (magnetic resonance imaging and positron emission tomography) to evaluate targeted medicinal therapy in terms of right heart remodelling. The safety profile of the drug was analyzed in the long-term post-registration international, multicenter, prospective, observational study EXPERT (NCT02092818), which confirmed the good tolerability and safety of riociguat therapy in PAH and CTEPH patients.

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Nitrogen oxide biochemical pathway in pulmonary arterial hypertension therapy and REPLACE trial results

Cited by 2 publications

References 35 publications

Optimization of specific therapy for pulmonary hypertension: the possibilities of riociguat

Optimization of specific therapy for pulmonary hypertension: the possibilities of riociguat

Soluble Guanylate Cyclase Stimulators for Chronic Thromboembolic Pulmonary Hypertension Patients Treatment: New Data

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