Long-Term Treatment of Primary Pulmonary Hypertension with Aerosolized Iloprost, a Prostacyclin Analogue
Marius M. Hoeper, M.D., Michael Schwarze, Stefan Ehlerding, Angelika Adler-Schuermeyer, R.N., Edda Spiekerkoetter, M.D., Jost Niedermeyer, M.D., Michael Hamm, M.D., and Helmut Fabel, M.D.
Background Continuous intravenous infusion of epoprostenol (prostacyclin)is an effective treatment for primary pulmonary hypertension.This approach requires the insertion of a permanent centralvenous catheter, with the associated risk of serious complications.Recently, aerosolized iloprost, a stable prostacyclin analogue,has been introduced as an alternative therapy for severe pulmonaryhypertension.
Methods We evaluated the effects of aerosolized iloprost onexercise capacity and hemodynamic variables over a one-yearperiod in patients with primary pulmonary hypertension.
Results Twenty-four patients with primary pulmonary hypertensionreceived aerosolized iloprost at a daily dose of 100 or 150µg for at least one year. The mean (±SD) distancecovered in the six-minute walk test increased from 278±96m at base line to 363± 135 m after 12 months (P<0.001).During the same period, the mean pulmonary arterial pressurebefore the inhalation of iloprost declined from 59±10mm Hg to 52±15 mm Hg (P=0.006), cardiac output increasedfrom 3.8±1.4 liters per minute to 4.4±1.3 litersper minute (P=0.02), and pulmonary vascular resistance declinedfrom 1205±467 dyn·sec·cm5 to 925±469dyn·sec·cm5 (P<0.001). The treatmentwas generally well tolerated, except for mild coughing, minorheadache, and jaw pain in some patients.
Conclusions Long-term treatment with aerosolized iloprost issafe and has sustained effects on exercise capacity and pulmonaryhemodynamics in patients with primary pulmonary hypertension.
Source Information
From the Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.
Address reprint requests to Dr. Hoeper at the Department of Respiratory Medicine, Hannover Medical School, 30623 Hannover, Germany, or at kmhoeper{at}aol.com.
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