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Liu YY, Qu YY, Wang S, Luo CJ, Qiu HL, Li HT, Yuan P, Wang L, Li JL, Jiang R, Zhang R. Efficacy and safety of riociguat replacing PDE-5is for patients with pulmonary arterial hypertension: A systematic review and meta-analysis. Front Pharmacol 2023; 14:1052546. [PMID: 36778016 PMCID: PMC9909097 DOI: 10.3389/fphar.2023.1052546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 01/11/2023] [Indexed: 01/27/2023] Open
Abstract
Introduction: Pulmonary arterial hypertension (PAH) is a rare and progressive disease. Some patients treated with phosphodiesterase type 5 inhibitors (PDE-5is) fail to reach treatment goals. As a novel soluble guanylate cyclase agonist, riociguat acts on the same pathway as PDE-5is but functions via different mechanisms. Whether riociguat is more effective and safer than PDE-5is is ambiguous. We aimed to evaluate the efficacy and safety of switching from PDE-5is to riociguat among these patients. Methods: Original published articles were retrieved from PubMed/Medline, Embase, Web of Science, Open Grey and Google Scholar. Studies that assessed the World Health Organization functional class (WHO-FC), 6-min walking distance (6MWD), pulmonary vascular resistance (PVR), mean pulmonary arterial pressure (mPAP), cardiac index (CI) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) were collected. Adverse events after switching were evaluated. Results: Ten published studies were included. Compared to PDE-5is, riociguat significantly increased the 6MWD by 26.45 m weighted mean difference (WMD) = 26.45 m, 95% confidence intervals (CIs): 9.70-43.2 m, p = 0.002) and improved mPAP (WMD = -3.53, 95% CIs: -5.62-1.44 mmHg, p = 0.0009), PVR (WMD = -130.24 dyn·s·cm-5, 95% CI -187.43-73.05, p < 0.0001), CIs (WMD = 0.36 L/min·cm-2, 95% CIs: 0.25-0.47, p < 0.00001) and WHO-FC (OR = 0.11, 95% CIs: 0.08-0.16, p < 0.0001) but not NT-proBNP. In addition, we did not observe the most common side effects during the replacement of riociguat for PDE-5is. Conclusions: PAH patients benefit from PDE-5is compared to riociguat, including in hemodynamic parameters, 6MWD, WHO-FC and biomarkers.
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Affiliation(s)
- Yu-Yang Liu
- Department of Cardiopulmonary Circulation, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yi-Yang Qu
- Department of Cardiopulmonary Circulation, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Shang Wang
- Department of Cardiopulmonary Circulation, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Ci-Jun Luo
- Department of Cardiopulmonary Circulation, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Hong-Ling Qiu
- Department of Cardiopulmonary Circulation, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Hui-Ting Li
- Department of Cardiopulmonary Circulation, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Ping Yuan
- Department of Cardiopulmonary Circulation, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Lan Wang
- Department of Cardiopulmonary Circulation, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Jin-Ling Li
- Department of Cardiopulmonary Circulation, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China.,Department of Cardiology, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Rong Jiang
- Department of Cardiopulmonary Circulation, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Rui Zhang
- Department of Cardiology, Affiliated Hospital of Qingdao University, Qingdao, China
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2
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Benza RL, Langleben D, Hemnes AR, Vonk Noordegraaf A, Rosenkranz S, Thenappan T, Hassoun PM, Preston IR, Ghio S, Badagliacca R, Vizza CD, Lang IM, Meier C, Grünig E. Riociguat and the right ventricle in pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension. Eur Respir Rev 2022; 31:31/166/220061. [PMID: 36198418 DOI: 10.1183/16000617.0061-2022] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 07/22/2022] [Indexed: 11/05/2022] Open
Abstract
Pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) are progressive diseases that can lead to right heart failure and death. Right ventricular dysfunction, hypertrophy and maladaptive remodelling are consequences of increased right ventricular (RV) afterload in PAH and CTEPH and are indicative of long-term outcomes. Because RV failure is the main cause of morbidity and mortality in PAH and CTEPH, successful treatments should lead to improvements in RV parameters. Riociguat is a soluble guanylate cyclase stimulator approved for the treatment of PAH and inoperable or persistent/recurrent CTEPH after pulmonary endarterectomy. This review examines the current evidence showing the effect of riociguat on the right ventricle, with particular focus on remodelling, function and structural parameters in preclinical models and patients with PAH or CTEPH.
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Affiliation(s)
- Raymond L Benza
- Dept of Medicine, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - David Langleben
- Center for Pulmonary Vascular Disease, Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Canada
| | - Anna R Hemnes
- Division of Allergy, Pulmonary and Critical Care Medicine, Dept of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Stephan Rosenkranz
- Dept of Cardiology and Cologne Cardiovascular Research Center, Cologne University Heart Center, Cologne, Germany
| | - Thenappan Thenappan
- Cardiovascular Division, Dept of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Paul M Hassoun
- Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Ioana R Preston
- Pulmonary, Critical Care and Sleep Medicine Division, Tufts Medical Center, Boston, MA, USA
| | - Stefano Ghio
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | | | - Irene M Lang
- Division of Cardiology, Dept of Internal Medicine II, Medical University of Vienna, Allgemeines Krankenhaus, Vienna, Austria
| | | | - Ekkehard Grünig
- Centre for Pulmonary Hypertension, Thoraxklinik-Heidelberg gGmbH, Heidelberg University Hospital, Heidelberg, Germany.,Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
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3
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Marchetta S, Verbelen T, Claessen G, Quarck R, Delcroix M, Godinas L. A Comprehensive Assessment of Right Ventricular Function in Chronic Thromboembolic Pulmonary Hypertension. J Clin Med 2022; 12:jcm12010047. [PMID: 36614845 PMCID: PMC9821031 DOI: 10.3390/jcm12010047] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/13/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022] Open
Abstract
While chronic thromboembolic pulmonary hypertension (CTEPH) results from macroscopic and microscopic obstruction of the pulmonary vascular bed, the function of the right ventricle (RV) and increased RV afterload are the main determinants of its symptoms and prognosis. In this review, we assess RV function in patients diagnosed with CTEPH with a focus on the contributions of RV afterload and dysfunction to the pathogenesis of this disease. We will also discuss changes in RV function and geometry in response to treatment, including medical therapy, pulmonary endarterectomy, and balloon pulmonary angioplasty.
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Affiliation(s)
| | - Tom Verbelen
- Department of Cardiac Surgery, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Guido Claessen
- Department of Cardiology, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Rozenn Quarck
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chonic Diseases and Metabolism (CHROMETA), KU Leuven, 3000 Leuven, Belgium
| | - Marion Delcroix
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chonic Diseases and Metabolism (CHROMETA), KU Leuven, 3000 Leuven, Belgium
- Department of Pneumology, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Laurent Godinas
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chonic Diseases and Metabolism (CHROMETA), KU Leuven, 3000 Leuven, Belgium
- Department of Pneumology, University Hospitals Leuven, 3000 Leuven, Belgium
- Correspondence:
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4
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Giesinger RE, Stanford AH, Thomas B, Abman SH, McNamara PJ. Safety and Feasibility of Riociguat Therapy for the Treatment of Chronic Pulmonary Arterial Hypertension in Infancy. J Pediatr 2022; 255:224-229.e1. [PMID: 36462687 DOI: 10.1016/j.jpeds.2022.11.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/26/2022] [Accepted: 11/18/2022] [Indexed: 12/03/2022]
Abstract
The effects of riociguat, an oral-soluble guanylate-cyclase stimulator, were studied in 10 infants with chronic pulmonary arterial hypertension. Respiratory status (n = 8/10), right heart dilation (n = 7/10), function (n = 9/10), and chronic pulmonary arterial hypertension (n = 8/10) improved. Median decrement in systolic (12 [4, 14]), diastolic (14 [7, 20]), and mean arterial (14 [10, 17]) pressures were noted; no critical hypotension or hypoxemia occurred.
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Affiliation(s)
| | - Amy H Stanford
- Department of Pediatrics, University of Iowa, Iowa City, IA
| | - Brady Thomas
- Department of Pediatrics, University of Iowa, Iowa City, IA
| | - Steven H Abman
- Department of Pediatrics, University of Colorado, Denver, CO
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5
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Martynyuk TV, Shmalts AA, Gorbachevsky SV, Chazova IE. Optimization of specific therapy for pulmonary hypertension: the possibilities of riociguat. TERAPEVT ARKH 2021; 93:1117-1124. [DOI: 10.26442/00403660.2021.09.201014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 10/10/2021] [Indexed: 11/22/2022]
Abstract
Pulmonary hypertension (PH) is a severe and often rapidly progressive disease with fatal outcome. Endothelial dysfunction in PH is associated with decreased nitric oxide production. After reviewing the mechanisms of action and the evidence base for specific therapy with phosphodiesterase 5 inhibitors (PDE-5) and soluble guanylate cyclase stimulators, a reseach review on switching from PDE-5 to riociguat is conducted. A potential advantage of riociguat is its independence from endogenous nitric oxide and from the other (besides PDE-5) isoenzymes of phosphodiesterases. The favorable efficacy profile of sildenafil has been proven for the main forms of pulmonary arterial hypertension, of riociguat for the main forms of pulmonary arterial hypertension and chronic thromboembolic PH. The clinical efficacy of replacing PDE-5 with riociguat has been demonstrated in uncontrolled trials and in the randomized controlled study REPLACE. The possibility of therapy optimization by switching from IFDE-5 to riociguat is fixed in the Russian (class and level of evidence B-3) and Eurasian (class and level of evidence IIb-B) clinical guidelines, as well as in the materials of the Cologne Expert Consensus. An additional argument for switching is the lower cost as compared to combination therapy in the Russian Federation. According to the Russian and Eurasian guidelines for PH and the Russian instructions for the use of riociguat, the drug should be taken at least 24 hours after sildenafil discontinuation.
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6
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Chong CZ, Tay ELW, Sia CH, Poh KK. Chronic thromboembolic pulmonary hypertension: a review. Singapore Med J 2021; 62:318-325. [PMID: 34409465 DOI: 10.11622/smedj.2021089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Chronic thromboembolic pulmonary hypertension (CTEPH) is a unique form of pulmonary hypertension resulting from obstruction of the pulmonary artery by fibrotic thromboembolic material, usually initiated by recurrent or incomplete resolution of pulmonary embolism. This distinct form of pulmonary hypertension is classified under Group 4 of the World Health Organization classification. Further investigations are usually initiated, with transthoracic echocardiography followed by right heart catheterisation and pulmonary angiography as the gold standard. Definitive treatment is usually in the form of surgical pulmonary endarterectomy. Inoperable CTEPH is medically treated with pharmacological agents such as phosphodiesterase Type 5 inhibitors, endothelin receptor antagonists, soluble guanylate cyclase stimulators and prostacyclin. Recent developments have made balloon pulmonary angioplasty a viable option as well.
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Affiliation(s)
- Cheryl Zhiya Chong
- Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Edgar Lik Wui Tay
- Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Ching Hui Sia
- Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Kian Keong Poh
- Department of Cardiology, National University Heart Centre Singapore, Singapore
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7
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Sharma R, Yadav L, Yadav RK, Chaudhary S. Oxidative cross-dehydrogenative coupling (CDC) via C (sp2)-H bond functionalization: tert-butyl peroxybenzoate (TBPB)-promoted regioselective direct C-3 acylation/benzoylation of 2 H-indazoles with aldehydes/benzyl alcohols/styrenes. RSC Adv 2021; 11:14178-14192. [PMID: 35423939 PMCID: PMC8698059 DOI: 10.1039/d1ra02225c] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 03/26/2021] [Indexed: 12/14/2022] Open
Abstract
An efficient, cost-effective, transition-metal-free, oxidative C(sp2)–H/C(sp2)–H cross-dehydrogenative coupling via a C(sp2)–H bond functionalization protocol for the regioselective direct C-3 acylation/benzoylation of substituted 2H-Indazoles 1a–m with substituted aldehydes 2a–q/benzyl alcohols 5a–e/styrenes 6a–e is reported. The operationally simple protocol proceeds in the presence of tert-butyl peroxybenzoate (TBPB) as an oxidant in chlorobenzene (PhCl) as a solvent at 110 °C for 24 h under an inert atmosphere, which furnished a diverse variety of substituted 3-(acyl/benzoyl)-2H-indazoles 3a–q/4a–l in up to 87% yields. The reaction involves a free-radical mechanism and proceeds via the addition of an in situ generated acyl radical (from aldehydes/benzyl alcohols/styrenes) on 2H-indazoles. The functional group tolerance, broad substrate scope, control/competitive experiments and gram-scale synthesis and its application to the synthesis of anti-inflammatory agent 11 and novel indazole-fused diazepine 13 further signify the versatile nature of the developed methodology. An efficient transition-metal-free oxidative C(sp2)–H/C(sp2)–H cross-dehydrogenative coupling via C(sp2)–H bond functionalization for regioselective C-3 acylation/benzoylation of 2H-indazoles with aldehydes/benzyl alcohols/styrenes is reported.![]()
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Affiliation(s)
- Richa Sharma
- Laboratory of Organic and Medicinal Chemistry (OMC Lab), Department of Chemistry, Malaviya National Institute of Technology Jawaharlal Nehru Marg Jaipur-302017 India +911412529029 +911412713319
| | - Lalit Yadav
- Laboratory of Organic and Medicinal Chemistry (OMC Lab), Department of Chemistry, Malaviya National Institute of Technology Jawaharlal Nehru Marg Jaipur-302017 India +911412529029 +911412713319
| | - Ravi Kant Yadav
- Laboratory of Organic and Medicinal Chemistry (OMC Lab), Department of Chemistry, Malaviya National Institute of Technology Jawaharlal Nehru Marg Jaipur-302017 India +911412529029 +911412713319
| | - Sandeep Chaudhary
- Laboratory of Organic and Medicinal Chemistry (OMC Lab), Department of Chemistry, Malaviya National Institute of Technology Jawaharlal Nehru Marg Jaipur-302017 India +911412529029 +911412713319
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8
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Kopeć G, Dzikowska-Diduch O, Mroczek E, Mularek-Kubzdela T, Chrzanowski Ł, Skoczylas I, Tomaszewski M, Peregud-Pogorzelska M, Karasek D, Lewicka E, Jacheć W, Gąsior Z, Błaszczak P, Ptaszyńska-Kopczyńska K, Mizia-Stec K, Biederman A, Zieliński D, Przybylski R, Kędzierski P, Waligóra M, Roik M, Grabka M, Orłowska J, Araszkiewicz A, Banaszkiewicz M, Sławek-Szmyt S, Darocha S, Magoń W, Dąbrowska-Kugacka A, Stępniewski J, Jonas K, Kamiński K, Kasprzak JD, Podolec P, Pruszczyk P, Torbicki A, Kurzyna M. Characteristics and outcomes of patients with chronic thromboembolic pulmonary hypertension in the era of modern therapeutic approaches: data from the Polish multicenter registry (BNP-PL). Ther Adv Chronic Dis 2021; 12:20406223211002961. [PMID: 33854746 PMCID: PMC8010818 DOI: 10.1177/20406223211002961] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 02/24/2021] [Indexed: 12/13/2022] Open
Abstract
Background: Significant achievements in the treatment of chronic thromboembolic pulmonary hypertension (CTEPH) have provided effective therapeutic options for most patients. However, the true impact of the changed landscape of CTEPH therapies on patients’ management and outcomes is poorly known. We aimed to characterize the incidence, clinical characteristics, and outcomes of CTEPH patients in the modern era of CTEPH therapies. Methods: We analyzed the data of CTEPH adults enrolled in the prospective multicenter registry. Results: We enrolled 516 patients aged 63.8 ± 15.4 years. The incidence rate of CTEPH was 3.96 per million adults per year. The group was burdened with several comorbidities. New oral anticoagulants (n = 301; 58.3%) were preferred over vitamin K antagonists (n = 159; 30.8%). Pulmonary endarterectomy (PEA) was performed in 120 (23.3%) patients and balloon pulmonary angioplasty (BPA) in 258 (50%) patients. PEA was pretreated with targeted pharmacotherapy in 19 (15.8%) patients, and BPA in 124 (48.1%) patients. Persistent CTEPH was present in 46% of PEA patients and in 65% of patients after completion of BPA. Persistent CTEPH after PEA was treated with targeted pharmacotherapy in 72% and with BPA in 27.7% of patients. At a mean time period of 14.3 ± 5.8 months, 26 patients had died. The use of PEA or BPA was associated with better survival than the use of solely medical treatment. Conclusions: The modern population of CTEPH patients comprises mostly elderly people significantly burdened with comorbid conditions. This calls for treatment decisions that are tailored individually for every patient. The combination of two or three methods is currently a frequent approach in the treatment of CTEPH. Clinical Trial Registration: clinicaltrials.gov/ct2/show/NCT03959748
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Affiliation(s)
- Grzegorz Kopeć
- Pulmonary Circulation Centre, Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, ul. Pradnicka 80, Krakow 31-202, Poland
| | - Olga Dzikowska-Diduch
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Ewa Mroczek
- Department of Cardiology, Provincial Specialist Hospital Research and Development Center, Wrocław, Poland
| | | | - Łukasz Chrzanowski
- I Department and Chair of Cardiology, Medical University of Lodz, Łódź, Poland
| | - Ilona Skoczylas
- 3rd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | | | | | - Danuta Karasek
- 2nd Department of Cardiology, Faculty of Health Sciences, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Ewa Lewicka
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Gdańsk, Poland
| | - Wojciech Jacheć
- 2nd Department of Cardiology, School of Medicine with Dentistry Division in Zabrze, Medical University of Silesia, Zabrze, Poland
| | - Zbigniew Gąsior
- Department of Cardiology, School of Health Sciences, Medical University of Silesia, Katowice, Poland
| | - Piotr Błaszczak
- Department of Cardiology, Cardinal Wyszynski Hospital, Lublin, Poland
| | | | - Katarzyna Mizia-Stec
- 1st Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | | | | | - Roman Przybylski
- Department of Heart Diseases, Wroclaw Medical University, Clinic of Cardiac Transplantation and Mechanical Circulatory Support, Wrocław, Poland
| | - Piotr Kędzierski
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, Otwock, Poland
| | - Marcin Waligóra
- Pulmonary Circulation Centre Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Kraków, Poland, Department of Medical Education, Center for Innovative Medical Education, Jagiellonian University Medical College, Krakow, Poland
| | - Marek Roik
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Marek Grabka
- 1st Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Joanna Orłowska
- Department of Cardiology, Provincial Specialist Hospital Research and Development Center, Wrocław, Poland
| | | | - Marta Banaszkiewicz
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, Otwock, Poland
| | - Sylwia Sławek-Szmyt
- Department of Cardiology, Poznan University of Medical Sciences, Poznań, Poland
| | - Szymon Darocha
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, Otwock, Poland
| | - Wojciech Magoń
- Pulmonary Circulation Centre, Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
| | | | - Jakub Stępniewski
- Pulmonary Circulation Centre Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Kraków, Poland, Department of Medical Education, Center for Innovative Medical Education, Jagiellonian University Medical College, Krakow, Poland
| | - Kamil Jonas
- Pulmonary Circulation Centre Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Kraków, Poland, Department of Medical Education, Center for Innovative Medical Education, Jagiellonian University Medical College, Krakow, Poland
| | - Karol Kamiński
- Department of Population Medicine and Lifestyle Diseases Prevention, Medical University of Białystok, Białystok, Poland
| | - Jarosław D Kasprzak
- I Department and Chair of Cardiology, Medical University of Lodz, Łódź, Poland
| | - Piotr Podolec
- Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Kraków, Poland
| | - Piotr Pruszczyk
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Adam Torbicki
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, Otwock, Poland
| | - Marcin Kurzyna
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, Otwock, Poland
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9
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Gratsianskaya SE, Valieva ZS, Martynyuk TV. [The achievements of the modern specific therapy of pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension: focus on the stimulator of soluble guanylate cyclase riociguat]. TERAPEVT ARKH 2020; 92:77-84. [PMID: 33346435 DOI: 10.26442/00403660.2020.09.000717] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 10/13/2020] [Indexed: 11/22/2022]
Abstract
Currently, treatment of pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) is focused on three signaling pathways: the NO pathway, the endothelin pathway, and the prostacyclin pathway. Riociguat is the only representative of stimulators of the soluble guanylate cyclase (sGC) class that is approved for the treatment of PAH and inoperable and persistent/recurrent CTEPH. The review presents data from clinical trials showing a positive effect of riociguat on the functional and hemodynamic profile of patients with PAH and CTEPH. In recent years there has been much discussion about the possibility of optimizing therapy by switching to drugs that affect a single pathogenesis target. Thus, sGC stimulants have obvious advantages over phosphodiesterase type 5 (PDE-5) inhibitors, including the ability of riociguat to exert pharmacological effects (due to a NO-independent mechanism of action) even in conditions of reduced NO production. Switching from PDE-5 to riociguat may be safe and appropriate, according to clinical trials presented in the review. In accordance with the guidelines for the diagnosis and treatment of pulmonary hypertension of the Eurasian Association of cardiologists from 2019, this strategy is approved when PDE5 therapy is ineffective in patients with PAH FC III (WHO).
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Affiliation(s)
- S E Gratsianskaya
- Myasnikov Institute of Clinical Cardiology, National Medical Research Center for Cardiology
| | - Z S Valieva
- Myasnikov Institute of Clinical Cardiology, National Medical Research Center for Cardiology
| | - T V Martynyuk
- Myasnikov Institute of Clinical Cardiology, National Medical Research Center for Cardiology.,Pirogov Russian National Research Medical University
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10
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Siennicka A, Darocha S, Banaszkiewicz M, Kędzierski P, Dobosiewicz A, Błaszczak P, Peregud-Pogorzelska M, Kasprzak JD, Tomaszewski M, Mroczek E, Zięba B, Karasek D, Ptaszyńska-Kopczyńska K, Mizia-Stec K, Mularek-Kubzdela T, Doboszyńska A, Lewicka E, Ruchała M, Lewandowski M, Łukasik S, Chrzanowski Ł, Zieliński D, Torbicki A, Kurzyna M. Treatment of chronic thromboembolic pulmonary hypertension in a multidisciplinary team. Ther Adv Respir Dis 2020; 13:1753466619891529. [PMID: 31878837 PMCID: PMC6935880 DOI: 10.1177/1753466619891529] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background: Chronic thromboembolic pulmonary hypertension (CTEPH) may be treated with pulmonary endarterectomy (PEA), balloon pulmonary angioplasty (BPA) and medical therapy (MT). Assessment in a multidisciplinary team of experts (CTEPH team) is currently recommended for treatment decision making. The aim of the present study was to report the effects of such an interdisciplinary concept. Methods and results: A total of 160 patients were consulted by the CTEPH team between December 2015 and September 2018. Patient baseline characteristics, CTEPH team decisions and implementation rates of diagnostic and therapeutic procedures were analysed. Change in World Health Organization (WHO) functional class and survival rates were evaluated by treatment strategy. A total of 51 (32%) patients were assessed as operable and 109 (68%) were deemed inoperable. Thirty-one (61% of operable patients) underwent PEA. Patients treated with PEA, BPA(+MT) and MT alone were 50.9 ± 14.7, 62.9 ± 15.1 and 68.9 ± 12.7 years old, respectively. At the follow-up, PEA patients had the highest WHO functional class improvement. Patients treated with BPA(+MT) had significantly better survival than PEA (p = 0.04) and MT patients (p = 0.04; 2-year survival of 92%, 79% and 79%, respectively). Conclusions: The CTEPH team ensures that necessary diagnostic procedures are performed. A relatively low proportion of patients was assessed by the CTEPH team as operable and underwent surgery, which in survivors resulted in the best functional improvement. Although patients undergoing BPA(+MT) were older than patients treated with PEA, their survival was better than patients subjected to PEA or MT alone. The reviews of this paper are available via the supplemental material section.
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Affiliation(s)
- Anna Siennicka
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Szymon Darocha
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, Fryderyk Chopin Hospital in European Health Centre Otwock, Borowa 14/18, Otwock, Mazowieckie, 05-400, Poland
| | - Marta Banaszkiewicz
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, European Health Centre Otwock, Centre of Postgraduate Medical Education, Poland
| | - Piotr Kędzierski
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, European Health Centre Otwock, Centre of Postgraduate Medical Education, Poland
| | - Anna Dobosiewicz
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, European Health Centre Otwock, Centre of Postgraduate Medical Education, Poland
| | - Piotr Błaszczak
- Department of Cardiology, Cardinal Wyszynski' Hospital, Lublin, Poland
| | | | | | | | - Ewa Mroczek
- Department of Cardiology, Regional Specialist Hospital, Research and Development Center, Wrocław, Poland
| | - Bożena Zięba
- University Clinical Centre, Medical University of Gdańsk, Gdańsk, Poland
| | - Danuta Karasek
- 2nd Department of Cardiology, Faculty of Health Sciences, Collegium Medicum, Nicolaus, Copernicus University, Poland
| | | | - Katarzyna Mizia-Stec
- First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | | | - Anna Doboszyńska
- Pulmonary Department, Pulmonary Hospital, University of Warmia and Mazury, Olsztyn, Poland
| | - Ewa Lewicka
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdansk, Poland
| | - Marcin Ruchała
- Department of Cardiology, Cardinal Wyszynski' Hospital, Lublin, Poland
| | - Maciej Lewandowski
- Department of Cardiology, Pomeranian Medical University, Szczecin, Poland
| | - Sylwia Łukasik
- Department of Cardiology, Medical University of Lublin, Lublin, Poland
| | - Łukasz Chrzanowski
- 1st Department of Cardiology, Biegański Hospital, Medical University of Łódź, Łódź, Poland
| | | | - Adam Torbicki
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, European Health Centre Otwock, Centre of Postgraduate Medical Education, Poland
| | - Marcin Kurzyna
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, European Health Centre Otwock, Centre of Postgraduate Medical Education, Poland
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Yadav L, Chaudhary S. Bu4NI-catalyzed, oxidative C(sp2)–C(sp3) cross dehydrogenative coupling for the regioselective direct C-3 benzylation of 2H-indazoles. Org Biomol Chem 2020; 18:5927-5936. [DOI: 10.1039/d0ob01282c] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
A Bu4NI-catalyzed, DTBP-promoted, regioselective C(sp2)–C(sp3) cross dehydrogenative coupling (CDC) protocol for the direct C-3 benzylation of 2H-indazoles is reported.
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Affiliation(s)
- Lalit Yadav
- Laboratory of Organic and Medicinal Chemistry (OMC Lab)
- Department of Chemistry
- Malaviya National Institute of Technology
- Jaipur 302017
- India
| | - Sandeep Chaudhary
- Laboratory of Organic and Medicinal Chemistry (OMC Lab)
- Department of Chemistry
- Malaviya National Institute of Technology
- Jaipur 302017
- India
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12
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Albani S, Biondi F, Stolfo D, Lo Giudice F, Sinagra G. Chronic thromboembolic pulmonary hypertension (CTEPH): what do we know about it? A comprehensive review of the literature. J Cardiovasc Med (Hagerstown) 2019; 20:159-168. [PMID: 30720636 DOI: 10.2459/jcm.0000000000000774] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
: Chronic thromboembolic disease (CTED), especially when associated with pulmonary hypertension (CTEPH), is a fearsome and under-diagnosed but potentially curable complication of pulmonary embolism, thanks to recent therapeutic options. Aspecific symptoms and signs make its diagnosis challenging, requiring clinicians to be ready to suspect its presence in patients with dyspnea of unknown origin or persistent symptoms after acute pulmonary embolism. The aim of this review is to provide an update to the general practitioner or the specialist physician on the state of the art regarding the epidemiology, pathophysiology and clinical management of chronic thromboembolic syndromes.
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Affiliation(s)
- Stefano Albani
- Cardiothoracic Department, Division of Cardiology and Postgraduate School in Cardiovascular Sciences, University of Trieste, Trieste, Italy
| | - Federico Biondi
- Cardiothoracic Department, Division of Cardiology and Postgraduate School in Cardiovascular Sciences, University of Trieste, Trieste, Italy
| | - Davide Stolfo
- Cardiothoracic Department, Division of Cardiology and Postgraduate School in Cardiovascular Sciences, University of Trieste, Trieste, Italy
| | - Francesco Lo Giudice
- Pulmonary Hypertension National Service, Hammersmith Hospital Imperial College NHS Trust, London, UK
| | - Gianfranco Sinagra
- Cardiothoracic Department, Division of Cardiology and Postgraduate School in Cardiovascular Sciences, University of Trieste, Trieste, Italy
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13
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Long-term clinical value and outcome of riociguat in chronic thromboembolic pulmonary hypertension. IJC HEART & VASCULATURE 2019; 22:163-168. [PMID: 30859124 PMCID: PMC6396196 DOI: 10.1016/j.ijcha.2019.02.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 02/10/2019] [Indexed: 12/24/2022]
Abstract
Background To improve clinical outcome, patients with inoperable and residual chronic thromboembolic pulmonary hypertension (CTEPH) can be treated with riociguat. The aim of this study is to explore long-term outcomes and to compare our 'real world' data with previous research. Methods We included all consecutive patients with technical inoperable and residual CTEPH, in whom riociguat therapy was initiated from January 2014 onwards, with patients followed till January 2019. Survival, clinical worsening (CW), functional class (FC), N-terminal pro brain natriuretic peptide (NT-proBNP) and 6-minute walking distance (6MWD) were described yearly after riociguat initiation. Results Thirty-six patients (50% female, mean age 64.9 ± 12.1 years, 54% WHO FC III/IV and 6MWD 337 ± 138 m could be included, with a mean follow-up of 2.3 ± 1.2 years. Survival and CW-free survival three years after initiation of riociguat were 94% and 78%, respectively. The 6MWD per 10 m at baseline was a significant predictor (HR 0.90 [0.83-0.97], p = 0.009) for CW. At three years follow-up the WHO FC and 6MWD improved and NT-proBNP decreased compared to baseline. Conclusion Our study confirms that riociguat is an effective treatment in patients with technical inoperable and residual CTEPH at long-term follow-up. Although our results are consistent with previous studies, more 'real world' research is necessary to confirm long-term results.
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Key Words
- 6MWD, 6-minute walking distance
- AE, adverse event
- BPA, balloon pulmonary angioplasty
- CHEST, Chronic Thromboembolic Pulmonary Hypertension Soluble Guanylate Cyclase-Stimulator Trial
- CO, cardiac output
- CTEPH, chronic thromboembolic pulmonary hypertension
- CW, clinical worsening
- Chronic thromboembolic pulmonary hypertension
- Clinical outcome
- Clinical worsening
- ERA, endothelin receptor antagonist
- FC, functional class
- HR, hazards regression
- NT-proBNP, N-terminal pro brain natriuretic peptide
- PAH, pulmonary arterial hypertension
- PAP, pulmonary arterial pressure
- PEA, pulmonary endarterectomy
- PH, pulmonary hypertension
- PVR, pulmonary vascular resistance
- RAP, right atrial pressure
- Residual PH, persistent pulmonary hypertension after PEA
- Riociguat
- SD, standard deviation
- Survival
- WHO, World Health Organization
- e.g., exempli gratiā
- i.e., id est
- mPAP, mean pulmonary arterial pressure
- sGC, soluble guanylate cyclase
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14
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Benza RL, Corris PA, Ghofrani HA, Kanwar M, McLaughlin VV, Raina A, Simonneau G. EXPRESS: Switching to riociguat: A potential treatment strategy for the management of CTEPH and PAH. Pulm Circ 2019; 10:2045894019837849. [PMID: 30803329 PMCID: PMC7074518 DOI: 10.1177/2045894019837849] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 02/08/2019] [Indexed: 12/22/2022] Open
Abstract
Currently, five classes of drug are approved for the treatment of pulmonary arterial hypertension (PAH): phosphodiesterase 5 inhibitors (PDE5i); endothelin receptor antagonists; prostacyclin analogs; the IP receptor agonist selexipag; and the soluble guanylate cyclase (sGC) stimulator riociguat. For patients with inoperable or persistent/recurrent chronic thromboembolic pulmonary hypertension (CTEPH), riociguat is currently the only approved pharmacotherapy. Despite the development of evidence-based guidelines on appropriate use of specific drugs, in clinical practice patients are often prescribed PAH-targeted therapies off label or at inadequate doses. PDE5i are the most often prescribed class of drugs as initial therapy, either alone or in combination with other drug classes. However, a proportion of patients receiving PAH therapies do not reach or maintain treatment goals. As PDE5i and riociguat target different molecules in the nitric oxide-sGC-cyclic guanosine monophosphate (NO-sGC-cGMP) signaling pathway, for patients with PAH without an initial or sustained response to PDE5i, there is a biological rationale for switching to riociguat. However, robust data from randomized controlled trials on the safety and efficacy of switching are lacking, as is formal guidance for clinicians. Here we review studies of sequential combination therapy, and trial data and case studies that have investigated switching between PAH-approved therapies, particularly from PDE5i to riociguat in patients with PAH with an insufficient response to PDE5i, and in patients with CTEPH who were receiving off-label treatment. These studies summarize the current evidence and practical real-life experience on the concept of switching treatments.
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Affiliation(s)
- Raymond L. Benza
- Cardiovascular Institute, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Paul A. Corris
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Hossein-Ardeschir Ghofrani
- University of Giessen and Marburg Lung Centre, Giessen, Germany, member of the German Centre for Lung Research (DZL)
- Department of Medicine, Imperial College London, London, UK
| | - Manreet Kanwar
- Cardiovascular Institute, Allegheny General Hospital, Pittsburgh, PA, USA
| | | | - Amresh Raina
- Cardiovascular Institute, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Gérald Simonneau
- Assistance Publique–Hôpitaux de Paris, Service de Pneumologie, Hôpital Bicêtre, Université Paris-Sud, Laboratoire d’Excellence en Recherche sur le Médicament et Innovation Thérapeutique, and INSERM Unité 999, Le Kremlin–Bicêtre, France
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15
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Khan MS, Amin E, Memon MM, Yamani N, Siddiqi TJ, Khan SU, Murad MH, Mookadam F, Figueredo VM, Doukky R, Benza RL, Krasuski RA. Meta-analysis of use of balloon pulmonary angioplasty in patients with inoperable chronic thromboembolic pulmonary hypertension. Int J Cardiol 2019; 291:134-139. [PMID: 30850238 DOI: 10.1016/j.ijcard.2019.02.051] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 02/05/2019] [Accepted: 02/22/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Current guidelines give balloon pulmonary angioplasty (BPA) a Class IIb recommendation for use in inoperable chronic thromboembolic pulmonary hypertension (CTEPH), as its safety and efficacy remain poorly defined. We conducted a systematic review and meta-analysis to evaluate BPA effectiveness. METHODS Medline, Cochrane Library and Scopus were searched for original studies from database inception dates until 24th May 2018. Prospective studies reporting outcomes before and after BPA in inoperable CTEPH patients were included. Studies with <20 patients were excluded. Data were pooled using a random effects model represented as weighted mean differences with 95% confidence intervals (CIs). RESULTS Seventeen noncomparative studies comprising 670 CTEPH patients (mean age 62 years; 68% women) were included. Meta-analysis showed significantly decreased mean pulmonary artery pressure (-14.2 mm Hg [95% CI -18.9, -9.5]), pulmonary vascular resistance (-303.5 dyn·s/cm5 [95% CI -377.6, -229.4]) and mean right atrial pressure (-2.7 mm Hg [95% CI -4.1, -1.3]) after BPA. Six-minute walk distance (67.3 m [95% CI 53.8, 80.8]) and cardiac output (0.2 l/min [95% CI 0.0, 0.3]) were significantly increased following BPA. From 12 studies reporting mortality with median follow-up of 9 months after BPA (range, 1-51 months), pooled incidence of short (≤1 month) and long-term mortality (>1 month) was 1.9% and 5.7%, respectively. CONCLUSION This systematic review and meta-analysis suggests mildly improved hemodynamics and overall low mortality rates following BPA in inoperable CTEPH patients. This non-comparative evidence can be used to facilitate decision making until the results of larger, controlled studies become available.
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Affiliation(s)
- Muhammad Shahzeb Khan
- Department of Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA.
| | - Emaan Amin
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | | | - Naser Yamani
- Department of Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA
| | - Tariq Jamal Siddiqi
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Safi U Khan
- Department of Internal Medicine, Robert Packer Hospital, Sayre, PA, USA
| | | | - Farouk Mookadam
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ, USA
| | - Vincent M Figueredo
- Sidney Kimmel College of Medicine at Thomas Jefferson University, Philadelphia, PA, USA
| | - Rami Doukky
- Division of Cardiology, Cook County Health and Hospitals System, Chicago, IL, USA
| | - Raymond L Benza
- Cardiovascular Institute, Allegheny Health Network, Pittsburgh, PA, USA
| | - Richard A Krasuski
- Department of Cardiovascular Medicine, Duke University Health System, Durham, NC, USA
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Switching from sildenafil to riociguat in patients with persistent or inoperable chronic thromboembolic pulmonary hypertension. Int J Cardiol 2019; 277:239. [DOI: 10.1016/j.ijcard.2018.09.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Accepted: 09/21/2018] [Indexed: 11/18/2022]
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17
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Darocha S, Banaszkiewicz M, Pietrasik A, Piłka M, Florczyk M, Wieteska M, Dobosiewicz A, Szmit S, Torbicki A, Kurzyna M. Response to letter from dr Altmayer regarding publication “Sequential treatment with sildenafil and riociguat in patients with persistent or inoperable chronic thromboembolic pulmonary hypertension improves functional class and pulmonary hemodynamics”. Int J Cardiol 2019; 276:240-241. [DOI: 10.1016/j.ijcard.2018.10.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 10/29/2018] [Indexed: 10/28/2022]
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18
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Ushkalova EA, Zyryanov SK, Zatolochina KE. Methods of Pharmacological Treatment of Chronic Thromboembolic Pulmonary Hypertension Current Approaches to the Patients Management. KARDIOLOGIYA 2018; 58:82-93. [PMID: 30625081 DOI: 10.18087/cardio.2018.11.10200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Accepted: 11/24/2018] [Indexed: 11/18/2022]
Abstract
In this paper we have discussed epidemiology, pathogenesis, and approaches to treatment of chronic thromboembolic pulmonary hypertension (CTEPH). CTEPH is a unique potentially curable form of pulmonary hypertension. The gold standard of CTEPH treatment is pulmonary thromboendarterectomy. However, about 40% of patients with CTEPH are inoperable due to distal surgically inaccessible lesions of the pulmonary vasculature, severe hemodynamic impairments, or other contraindications. In addition, nearly half of patients have persistent or recurrent pulmonary hypertension following surgery. Current guidelines support the use of pharmacotherapy in these patients. In the article we have presented results of main clinical studies of targeted drugs therapy (endothelin receptor antagonists, prostanoids, phosphodiesterase type 5 inhibitors, soluble guanylate cyclase stimulators) of patients with CTEPH. The only drug that has demonstrated robust clinical efficacy in terms of improvment hemodynamic parameters, exercise capacity and patients' quality of life is the stimulator of the soluble guanylate cyclase riociguat. The efficacy and safety of riociguat have been investigated in short-term and long-term studies with follow-up up to 6 years. Results of these studies have constituted the basis forits approval by the regulatory authorities of more than 50 countries for the treatment of inoperable CTEPH and persistent or recurrent CTEPH after pulmonary thromboendarterectomy. In the European Union, USA and many other countries, riociguat is the only pharmacological agent approved for these indications.
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Affiliation(s)
- E A Ushkalova
- Peoples Friendship University of Russia (RUDN University).
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