Managing PAH: The benefits of combination therapy

January 1, 2007

For patients with pulmonary arterial hypertension (PAH) who remain symptomatic despite therapy with bosentan, the addition of inhaled iloprost is beneficial, according to a study by McLaughlin and colleagues.

For patients with pulmonary arterial hypertension (PAH) who remain symptomatic despite therapy with bosentan, the addition of inhaled iloprost is beneficial, according to a study by McLaughlin and colleagues.

The study included 67 patients with PAH who continued to be symptomatic after receiving bosentan therapy for at least 4 months. The patients were randomly assigned to receive inhaled iloprost or placebo, in addition to bosentan, for 12 weeks.

After 12 weeks of combination therapy, the mean increase in the post-inhalation 6-minute walk distance was 30 m in the group that received iloprost, compared with 4 m in the placebo group. The mean increase in pre-inhalation distance was 29 m and 11 m, respectively. However, the 2 groups did not dif-fer significantly with respect to improvement in the Borg dyspnea score.

New York Heart Association status improved by one class in 34% of the iloprost group, compared with 6% of the placebo group. In addition, treatment with iloprost delayed the time to clinical worsening. Therapy with iloprost appeared to be well tolerated.