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Bosentan Therapy for Inoperable Chronic Thromboembolic Pulmonary Hypertension^*

^* From the Department of Respiratory Medicine (Drs. Hoeper and Welte, and Ms. Schulze), Hannover Medical School, Hannover; Department of Cardiovascular and Thoracic Surgery (Drs. Kramm and Mayer), University Hospital of Mainz, Mainz; and Departments of Respiratory Medicine (Dr. Wilkens) and Department of Cardiovascular and Thoracic Surgery (Dr. Schäfers), University of the Saarland, Homburg, Germany.

Correspondence to: Marius M. Hoeper, MD, Department of Respiratory Medicine, Hannover Medical School, 30623 Hannover, Germany; e-mail: hoeper.marius{at}mh-hannover.de

Study objectives: We performed an open-label multicenter study to evaluate the safety and efficacy of the dual endothelin receptor antagonist bosentan in patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH).

Patients: Nineteen patients with inoperable CTEPH were enrolled.

Measurements: The primary end point was a change in pulmonary vascular resistance (PVR). Secondary end points included 6-min walk test, peak oxygen uptake (O₂), New York Heart Association functional class, serum levels of N-terminal-pro brain natriuretic peptide (NT-pro-BNP), and various other hemodynamic parameters.

Results: After 3 months of treatment with bosentan, PVR decreased from 914 ± 329 to 611 ± 220 dyne·s·cm^-5 (p < 0.001). Functional class and peak O₂ remained unchanged, but 6-min walk distance increased from 340 ± 102 to 413 ± 130 m (p = 0.009), and serum NT-pro BNP levels improved from 2,895 ± 2,620 to 2,179 ± 2,301 (p = 0.027). One patient died, presumably from influenza A infection, and another patient experienced progressive fluid retention despite reduction of PVR. Other than that, treatment was well tolerated by all patients.

Conclusions: This open-label pilot trial suggests that bosentan may offer a therapeutic option for patients with inoperable CTEPH. Randomized controlled trials are warranted to confirm these findings.

Key Words: hypertension, pulmonary • thromboembolism, endothelin

This article has been cited by other articles:

				P. Bresser, J. Pepke-Zaba, X. Jais, M. Humbert, and M. M. Hoeper Medical Therapies for Chronic Thromboembolic Pulmonary Hypertension: An Evolving Treatment Paradigm Proceedings of the ATS, September 1, 2006; 3(7): 594 - 600. [Abstract] [Full Text] [PDF]

				L. J. Rubin, M. M. Hoeper, W. Klepetko, N. Galie, I. M. Lang, and G. Simonneau Current and Future Management of Chronic Thromboembolic Pulmonary Hypertension: From Diagnosis to Treatment Responses Proceedings of the ATS, September 1, 2006; 3(7): 601 - 607. [Abstract] [Full Text] [PDF]

				R. J. Hughes, X. Jais, D. Bonderman, J. Suntharalingam, M. Humbert, I. Lang, G. Simonneau, and J. Pepke-Zaba The efficacy of bosentan in inoperable chronic thromboembolic pulmonary hypertension: a 1-year follow-up study Eur. Respir. J., July 1, 2006; 28(1): 138 - 143. [Abstract] [Full Text] [PDF]