1. Home>
2. Specialties>
3. General Medicine>
4. Summary and Comment

Epoprostenol Plus Sildenafil for Pulmonary Arterial Hypertension?

Sildenafil was associated with longer 6-minute walk distances and higher quality of life in a study cohort, but we shouldn’t generalize these results just yet.

Epoprostenol (Flolan and generics) and sildenafil (Revatio, Viagra) lead to vasodilation via different mechanisms. Therefore, using both agents together could be more effective than using either one alone for patients with pulmonary arterial hypertension. In an international controlled trial sponsored by the manufacturer of sildenafil, 267 patients with pulmonary arterial hypertension who were receiving long-term IV epoprostenol were assigned randomly to placebo or sildenafil (titrated up to 80 mg thrice daily).

At 16 weeks, the sildenafil group exhibited a greater mean increase from baseline in 6-minute walk distance than did the placebo group (29.8 vs. 1.0 meters), with benefits concentrated mainly among those with baseline 6-minute walk distances of 325 meters. Patients in the sildenafil group also had greater improvements in health-related quality of life and longer time to clinical worsening, but no improvements were noted in dyspnea in either group. Some side effects were more common in the sildenafil group (i.e., headache, dyspepsia, limb pain, and nausea), but the proportion of patients who discontinued treatment because of adverse events was not significantly different between groups.

Comment: An editorialist points out that, in this study, the allowed dose adjustments for epoprostenol were smaller than those normally applied in practice; therefore, sildenafil might not have such noticeable benefits outside a trial setting. In addition, this study did not address the current practice of starting treatment with oral therapies. So, how these results apply to current practice is not clear yet.

— Richard Saitz, MD, MPH, FACP, FASAM

Published in Journal Watch General Medicine November 6, 2008

Citation(s):

Simonneau G et al. Addition of sildenafil to long-term intravenous epoprostenol therapy in patients with pulmonary arterial hypertension: A randomized trial. Ann Intern Med 2008 Oct 21; 149:521.

• Original article (Subscription may be required)
• Medline abstract (Free)

Taichman DB. Therapy for pulmonary arterial hypertension: The more, the merrier? Ann Intern Med 2008 Oct 21; 149:583.

• Original article (Subscription may be required)
• Medline abstract (Free)