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(Chest. 2006;130:1198-1202.)
© 2006 American College of Chest Physicians

The Current Treatment of Pulmonary Arterial Hypertension*

Time to Redefine Success

Stuart Rich, MD, FCCP

* From the Section of Cardiology, University of Chicago, Chicago, IL.

Correspondence to: Stuart Rich, MD, FCCP, University of Chicago, 5841 S Maryland Ave, MC 2016, Chicago, IL 60612; e-mail: srich{at}medicine.bsd.uchicago.edu

Abstract

In the past decade, three classes of medications have been approved for the treatment of pulmonary arterial hypertension. A review of the clinical trial data for the prostanoids, endothelin antagonists, and phosphodiesterase-5 inhibitors has shown that all agents have similar efficacy on the 6-min walk distance over 12 to 16 weeks, which was the primary end point in the randomized clinical trials. However, little is known about their long-term efficacy or about how these drugs affect the underlying disease, if at all. Successful therapy is currently defined as an improvement in exercise tolerance over a 4-month period. Future trials need to better characterize how therapies affect the pulmonary vasculature pathologically, biologically, and hemodynamically, and whether survival is actually improved.

Key Words: bosentan • clinical trials • prostacyclin • sildenafil




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