Switching to Riociguat Could Benefit Certain PAH Patients
Certain patients with pulmonary arterial hypertension (PAH) may benefit from switching from phosphodiesterase-5 inhibitors (PDE5i) to riociguat, according to the results of a recent study.
Some patients with PAH fail to reach treatment goals while taking PDE5i. In a recent study, researchers sought to determine the feasibility and benefits of switching from treatment with PDE5i to riociguat in these patients.
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In their 24-week, open-label, multicenter, uncontrolled study, researchers examined data from patients in Wolf Health Organization functional class III (WHO FC), with 6-minute walking distance (6MWD) of 165-440 m, cardiac index of <3.0 L·min−1·m−2 and pulmonary vascular resistance >400 dyn·s·cm−5.
After 1 to 3 days without PDE5i treatment, participants received riociguat at 2.5 mg maxiumum per day. Of the 61 patients, 51 competed the study. Fifty of the participants were receiving concomitant endothelin receptor antagonists.
Overall, at week 24 the mean±sd 6MWD had increased by 31±63 m, N-terminal prohormone of brain natriuretic peptide (NT-proBNP) decreased by 347±1235 pg·mL−1 and WHO FC improved in 28 patients (54%).
Thirty-two patients experience drug-related adverse events and 10 experienced serious adverse events, while 6 experienced clinical worsening, including 2 deaths.
“This study represents an important step towards determining if this new treatment strategy is an effective approach to the management of patients with PAH, although additional data from larger, randomized, controlled studies are needed to further establish the safety and efficacy of this approach,” the researchers concluded.
—Michael Potts
Reference:
Hoeper MM, Simonneau G, Corris PA, et al. RESPITE: switching to riociguat in pulmonary arterial hypertension patients with inadequate response to phosphodiesterase-5 inhibitors. Euro Respir J. 2017;50(3). doi:10.1183/13993003.02425-2016.