Clinical efficacy and survival with first-line inhaled iloprost therapy in patients with idiopathic pulmonary arterial hypertension

Christian F. Opitz, Roland Wensel, Jörg Winkler, Michael Halank, Leonhard Bruch, Franz Xaver Kleber, Gert Höffken, Stefan D. Anker, Abdissa Negassa, Stephan B. Felix, Roland Hetzer, Ralf Ewert

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144 Scopus citations

Abstract

Aims: To describe the long-term clinical efficacy of inhaled iloprost as first-line vasodilator mono-therapy in patients with idiopathic pulmonary arterial hypertension (IPAH). Methods and results: Seventy-six IPAH patients were prospectively identified and treated with inhaled iloprost. Clinical, haemodynamic, and exercise parameters were obtained at baseline, after 3 and 12 months of therapy and yearly thereafter. Four endpoints were prospectively defined as follows: (i) death, (ii) transplantation, (iii) switch to intravenous (i.v.) therapy, or (iv) addition of or switch to other active oral therapy. During follow-up (535 ± 61 days), 11 patients died, six were transplanted, 25 were switched to i.v. prostanoids, 16 received additional or other oral therapy, and 12 patients discontinued iloprost inhalation for other reasons. Event-free survival at 3, 12, 24, 36, 48, and 60 months was 81, 53, 29, 20, 17 and 13%, respectively. Among haemodynamic and exercise parameters, mixed venous oxygen saturation (P < 0.001), right atrial pressure (P < 0.001), and peak oxygen uptake (P = 0.002) were associated with event-free survival. Conclusion: In this study, only a minority of patients could be stabilized with inhaled iloprost monotherapy during a follow-up period of up to 5 years. In the presence of multiple treatment options, chronic iloprost inhalation as mono-therapy appears to have a limited role.

Original languageEnglish (US)
Pages (from-to)1895-1902
Number of pages8
JournalEuropean heart journal
Volume26
Issue number18
DOIs
StatePublished - Sep 1 2005

Keywords

  • Chronic therapy
  • Inhaled iloprost
  • Pulmonary arterial hypertension

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Opitz, C. F., Wensel, R., Winkler, J., Halank, M., Bruch, L., Kleber, F. X., Höffken, G., Anker, S. D., Negassa, A., Felix, S. B., Hetzer, R., & Ewert, R. (2005). Clinical efficacy and survival with first-line inhaled iloprost therapy in patients with idiopathic pulmonary arterial hypertension. European heart journal, 26(18), 1895-1902. https://doi.org/10.1093/eurheartj/ehi283