Managing PAH: The benefits of combination therapy

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.