Pulido ZT

Language: Spanish
References: 11
Page: 121-124
PDF size: 57.23 Kb.

ABSTRACT

In recent years, the better understanding of the pathobiology and pathogenesis of pulmonary arterial hypertension (PAH) has led to the development of new drugs for its treatment. Epoprostenol, which was the first drug approved for PAH, has shown an improvement in the survival at 3 years in patients with primary pulmonary hypertension. Recently, the Food and Drug Administration has approved two new compounds, Bosentan (an oral, non-selective endothelin receptor blocker) and Treprostinil (a subcutaneous prostacyclin analog). At least three multicenter, international studies are currently in progress. These studies include the use of a diet supplement rich in arginine (nitric oxide precursor), the evaluation of an endothelin A-receptor blocker (Sitaxsentan), and the evaluation of Sildenafil (a 5-phosphodiesterase inhibitor). As long as research continues to scrutinize the pathogenesis of this disease, clues to possible new therapies are warranted.

REFERENCES

1. Moncada S, Grylewski R, Bunting S, Vane JR: An enzyme isolated from arteries transforms prostaglandin endoperoxides to an unstable substance that inhibits platelet aggregation. Nature 1976; 263: 663-665.

2. Barst RJ, Rubin LJ, Long WA, McGoon MD, Rich S, Badesch D, et al: A comparison of continuous intravenous Epoprostenol (Prostacyclin) with conventional therapy for primary pulmonary hypertension. N Engl J Med 1996; 334: 296-301.

3. Simonneau G, Barst RJ, Galié N, Naeije R, Rich S, Bourge RC, et al: Continuous subcutaneous infusion of Treprostinil, a Prostacyclin analogue, in patients with pulmonary arterial hypertension. A double-blind, randomized, placebo-controlled trial. Am J Respir Crit Care Med 2002; 165: 800-804.

4. Galié N, Humbert M, Vachiéry JL, Vizza CD, Kneussl M, Manes A, et al: Effects of beraprost, an oral prostacyclin analogue, in patients with pulmonary arterial hypertension: a randomized, double-blind, placebo-controlled trial. J Am Coll Cardiol 2002; 39: 1496-1502.

5. Olschewski H, Simonneau G, Galié N, Higenbottam T, Naeije R, Rubin LJ, et al: Inhaled Iloprost for severe pulmonary hypertension. N Engl J Med 2002; 347: 322-329.

6. McLaughlin V, Shillington A, Rich S: Survival in primary pulmonary hypertension: The impact of Epoprostenol therapy. Circulation 2002; 106: 1477-1482.

7. Tuder RM, Cool CD, Yeager M, Taraseviciene-Stewart L, Bull TM, Voelkel N: The pathobiology of pulmonary hypertension. Endothelium. Clin Chest Med 2001; 22: 405-418.

8. Rubin LJ, Badesch D, Barst RJ, Galié N, Black CM, Keogh A, et al: Bosentan therapy for pulmonary arterial hypertension. N Engl J Med 2002; 346: 896-903.

9. Barst RJ, Rich S, Widlitz A, Horn E, McLaughlin V, McFarlin J: Clinical efficacy of sitaxsentan, an Endothelin-A receptor antagonist, in patients with pulmonary arterial hypertension: Open-label pilot study. Chest 2002; 121: 1860-1868.

10. Nagaya N, Uematsu M, Oya H, Sato N, Sakamaki F, Kyotani S, et al: Short-term oral administration of L-arginine improves hemodynamics and exercise capacity in patients with precapillary pulmonary hypertension. Am J Respir Crit Care Med 2002; 163: 887-891.

11. Michelakis E, Tymchak W, Lien D, Webster L, Hashimoto K, Archer S: Oral sildenafil is an effective and specific pulmonary vasodilator in patients with pulmonary arterial hypertension: comparison with nitric oxide. Circulation 2002; 105: 2398-2403.