Medical treatment value questioned for operable CTEPH
MedWire News: Medical pulmonary hypertensive therapy (PHT) does not benefit most patients with operable chronic thromboembolic pulmonary hypertension (CTEPH), suggest US researchers.
“The use of these medications delayed the time to referral with presumed associated increased health resource utilization without any apparent postoperative outcome benefits,” report Kim Kerr and co-workers from the University of California at San Diego.
PHT medications are increasingly used for patients with CTEPH despite a lack of evidence for their efficacy, possibly due to their successful use in patients with pulmonary artery hypertension, the team observes.
To investigate the efficacy of PHT in CTEPH patients suitable for pulmonary thromboendarterectomy (PTE), the team reviewed data from CTEPH patients treated at their hospital between 2005 and 2007.
This included 111 patients who received PHT before surgery and 244 patients who did not. PHT consisted of monotherapy with bosentan, sildenafil, or epoprostenol and combination therapy.
During the study period, PHT use increased from 19.9% of patients to 37.0%, the team reports in the journal Circulation.
The researchers found that PHT was associated with a minimal but significant improvement in pre-PTE pulmonary artery pressure in treated patients. Patients given epoprostenol showed a significant improvement in total pulmonary resistance between diagnosis of CTEPH and referral for surgery.
However, PHT was also associated with significant time delay in referral for surgery (8.9 vs 4.4 months). Furthermore, there was no significant difference in improvements in hemodynamic parameters after PTE between patients who were and were not pretreated with PHT.
The researchers suggest that patients with high pulmonary artery pressure and total pulmonary resistance who responded to epoprostenol may have more small vessel disease than other patients but that the patient group was too small to make any conclusions. “Future prospective studies involving PAH medications, particularly epoprostenol, are warranted to determine whether there is any value in treating CTEPH patients with these agents before surgery,” Kerr et al conclude.
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By Lynda Williams