Pharmacological option for inoperable chronic thromboembolic pulmonary
hypertension
Patients with inoperable chronic thromboembolic pulmonary hypertension can be successfully treated with the endothelin receptor antagonist bosentan (Tracleer), data from a phase III trial presented at last week's American
Thoracic Society meeting in San Francisco suggest.
Chronic thromboembolic pulmonary hypertension occurs when pulmonary arteries
become obstructed by thrombi, leading to increased vascular resistance.
The condition develops in up to 3.8 per cent of patients who survive
an acute pulmonary embolism. Standard treatment involves complex surgery
but patients may be unsuitable due to their age, coexisting conditions
or inaccessible thrombi.
The double-blind trial, known as
BENEFIT, looked at 157 of these patients and randomised them to receive
bosentan or placebo for 16 weeks.
Treatment with bosentan was associated with a 24.1 per cent drop in the
primary outcome of pulmonary vascular resistance (P<0.0001) and Borg
dyspnoea score improved by –0.6 (P=0.0386). However, functioning,
as measured by the six-minute walk test, remained unchanged in both groups.
Lewis Rubin, of the University of California, San Diego, and a member
of the BENEFIT steering group, commented: “We’re not quite
sure why the [six-minute walk test] didn’t improve but it might
be because these patients were fairly old [average age 63 years] and
it might take longer than this follow up to see improvements. But the
fact that PVR dropped with bosentan is significant.”
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