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Long-Term Effects of Sildenafil in Patients with Pulmonary Arterial Hypertension

Ryoji Yanagisawa

Masaharu Kataoka

Yuichi Tamura

Takashi Kawakami

H. Yoshino

Toru Satoh

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Conference: 2010 International PHA Conference and Scientific Sessions

Release Date: 06.24.2010

Presentation Type: Abstracts

Yanagisawa R1, Kataoka M1,2, Tamura U2, Kawakami2, Yoshino H1, Satoh T1,2
1. Department of Medicine, Division of Cardiology, Kyorin University School of Medicine, Tokyo, Japan 
2. Cardiology Division, Department of Medicine, Keio University School of Medicine, Tokyo, Japan

BACKGROUNDSildenafil, the oral drug used in pulmonary arterial hypertension (PAH), has been used in our hospital since 2003 on off-label basis. How sildenafil is effective was investigated.

METHODSSidenafil has been administered as a first-line drug to 49 patients with PAH in our hospital. Four patients abandoned sildenafil because of severe subjective side effects or high cost with off-label use. Seven patients with Eisenmenger syndrome were excluded because of difference from other PAH in clinical characteristics. The remaining 38 (39± 14 years old) were analyzed.

RESULTSThe etiologies are: idiopathic 23, collagen 10, and portal 5 in number. The patients were divided into 3 groups; Group 1 (n=21): only sildenafil has been administered. PVR (pulmonary vascular resistance) significantly improved from 16± 9 to 11± 6 units in 27± 23 months. Group 2 (n=11): intravenous epoprostenorol was added irrespective of bosentan addition. PVR changed from 22± 9 to 23± 9 units in 21± 25 months. Group 3 (n=4): bosentan was added. PVR significantly improved from 13± 3 to 8± 3 units in 9± 4 months. Caplan-Meier analysis was applied with an addition of epoprostenol as treatment failure, half the patients with administration of sildenafil were treated without addition of epoprostenol for 5 years.

CONCLUSIONSAbout 60% of the patients with sildenafil as a first-line drug were treated without an addition of epoprostenol for 2 years. These results could suggest the efficacy of sildenafil as a first-line therapy in patients with PAH.