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Previous Volume 347:322-329 August 1, 2002 Number 5 Next

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ABSTRACT

Background Uncontrolled studies suggested that aerosolized iloprost, a stable analogue of prostacyclin, causes selective pulmonary vasodilatation and improves hemodynamics and exercise capacity in patients with pulmonary hypertension.

Methods We compared repeated daily inhalations of 2.5 or 5.0 µg of iloprost (six or nine times per day; median inhaled dose, 30 µg per day) with inhalation of placebo. A total of 203 patients with selected forms of severe pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension (New York Heart Association [NYHA] functional class III or IV) were included. The primary end point was met if, after week 12, the NYHA class and distance walked in six minutes were improved by at least one class and at least 10 percent, respectively, in the absence of clinical deterioration according to predefined criteria and death.

Results The combined clinical end point was met by 16.8 percent of the patients receiving iloprost, as compared with 4.9 percent of the patients receiving placebo (P=0.007). There were increases in the distance walked in six minutes of 36.4 m in the iloprost group as a whole (P=0.004) and of 58.8 m in the subgroup of patients with primary pulmonary hypertension. Overall, 4.0 percent of patients in the iloprost group (including one who died) and 13.7 percent of those in the placebo group (including four who died) did not complete the study (P=0.024); the most common reason for withdrawal was clinical deterioration. As compared with base-line values, hemodynamic values were significantly improved at 12 weeks when measured after iloprost inhalation (P<0.001), were largely unchanged when measured before iloprost inhalation, and were significantly worse in the placebo group. Further significant beneficial effects of iloprost treatment included an improvement in the NYHA class (P=0.03), dyspnea (P=0.015), and quality of life (P=0.026). Syncope occurred with similar frequency in the two groups but was more frequently rated as serious in the iloprost group, although this adverse effect was not associated with clinical deterioration.

Conclusions Inhaled iloprost is an effective therapy for patients with severe pulmonary hypertension.

Source Information

From the Department of Internal Medicine II, University Clinic, Giessen, Germany (H.O., H.A.G., W.S.); Service de Pneumologie, Hôpital Antoine Béclère, Clamart, France (G.S., O.S.); Istituto di Cardiologia, Università di Bologna, Bologna, Italy (N.G., A.M.); Royal Hallamshire Hospital, Sheffield, United Kingdom (T.H., D.G.K.); Department of Cardiology, Erasme University Hospital, Brussels, Belgium (R.N.); University of California at San Diego Medical Center, La Jolla (L.J.R.); Schering, Berlin, Germany (S.N., H.S.); Department of Internal Medicine, University Hospital, Zurich, Switzerland (R.S., W.P.); Department of Pneumology, Hannover Medical School, Hannover, Germany (M.M.H.); the Division of Pulmonary Diseases, University of Munich–Großhadern, Munich, Germany (J.B.); Department of Pneumology, University Clinic, Leipzig, Germany (J.W.); Department of Pneumology and Infectious Diseases, Ernst Moritz Arndt University, Greisswald, Germany (R.E.); Bereich Pneumologie, Medizinische Kernklinik und Poliklinik, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany (A.M.); Freeman Hospital, High Heaton, Newcastle-upon-Tyne, United Kingdom (P.A.C.); Department of Pneumology, Gasthuisberg University Clinic, Leuven, Belgium (M.D.); and Pulmonary Hypertension Unit, Hospital 12 de Octubre, Madrid (M.G.-S.).

Address reprint requests to Dr. Seeger at the Department of Internal Medicine II, University Clinic, Klinikstr. 36, D-35392 Giessen, Germany, or at werner.seeger{at}innere.med.uni-giessen.de.

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