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Epoprostenol for Treatment of Pulmonary Hypertension in Patients With Systemic Lupus Erythematosus^*

^* From the Center for Lung Research, Department of Medicine (Drs. Robbins and Loyd), Vanderbilt University School of Medicine, Nashville, TN; Division of Pulmonary and Critical Care (Dr. Gaine), University of Maryland School of Medicine, Baltimore, MD; Division of Pulmonary and Critical Care (Dr. Schilz), Cleveland Clinic Foundation, Cleveland, OH; Division of Pulmonary and Critical Care Medicine (Dr. Tapson), Duke University Medical Center, Durham, NC; Division of Pulmonary and Critical Care Medicine (Dr. Rubin), UCSD Medical Center, San Diego, CA.

Correspondence to: Ivan M. Robbins, MD, Center for Lung Research, Room T-1217, MCN, Vanderbilt University School of Medicine, Nashville, TN 37232; e-mail: Ivan.Robbins{at}mcmail.vanderbilt.edu

Objective: Pulmonary hypertension with pathological changes similar to those observed in primary pulmonary hypertension occurs in patients with systemic lupus erythematosus (SLE). The efficacy of chronic epoprostenol therapy in SLE has not been well described. The objective of this paper is to describe our experience with long-term epoprostenol therapy in patients with pulmonary hypertension associated with SLE.

Design: Case series of six patients with SLE and associated pulmonary hypertension receiving chronic treatment with epoprostenol.

Results: All 6 patients had severe pulmonary hypertension. Mean pulmonary artery pressure (mPAP) was 57 ± 9 mm Hg (mean ± SD), and pulmonary vascular resistance was 14 ± 7 units before beginning therapy with epoprostenol. In 4 patients who underwent repeat hemodynamic evaluation (9 to 16 months after starting epoprostenol), mean pulmonary artery pressure decreased by 38 ± 21% and pulmonary vascular resistance by 58 ± 12%. Clinically, all patients improved from New York Heart Association class III or IV to class I or II. Doses of epoprostenol ranged from 4 to 46 ng/kg/min, and the longest duration of therapy has been 2.5 years. Side effects from epoprostenol have not differed from those seen in patients with primary pulmonary hypertension, and except for one patient, there has been no exacerbation of SLE.

Conclusion: Epoprostenol was effective for the treatment of pulmonary hypertension in this small group of patients with SLE. Further evaluation of epoprostenol therapy for patients with SLE and other diseases associated with pulmonary hypertension is warranted.

Key Words: epoprostenol • pulmonary hypertension • systemic lupus erythematosus

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