Initial Triple Combination Therapy Including Intravenous Prostaglandin I<sub>2</sub> for the Treatment of Patients with Severe Pulmonary Arterial Hypertension
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- Tamura Yuichi
- Pulmonary Hypertension Center, International University of Health and Welfare Mita Hospital Japan Pulmonary Hypertension Registry (JAPHR) Network
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- Kumamaru Hiraku
- Japan Pulmonary Hypertension Registry (JAPHR) Network Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo
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- Nishimura Shiori
- Japan Pulmonary Hypertension Registry (JAPHR) Network Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo
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- Nakajima Yasuo
- Medical Division, GSK K.K.
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- Matsubara Hiromi
- Japan Pulmonary Hypertension Registry (JAPHR) Network National Hospital Organization Okayama Medical Center
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- Taniguchi Yu
- Japan Pulmonary Hypertension Registry (JAPHR) Network Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
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- Tsujino Ichizo
- Japan Pulmonary Hypertension Registry (JAPHR) Network Division of Respiratory and Cardiovascular Innovative Research, Faculty of Medicine, Hokkaido University
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- Shigeta Ayako
- Japan Pulmonary Hypertension Registry (JAPHR) Network Department of Respirology, Graduate School of Medicine, Chiba University
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- Kinugawa Koichiro
- Japan Pulmonary Hypertension Registry (JAPHR) Network Second Department of Internal Medicine, University of Toyama
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- Kimura Kazuhiro
- Japan Pulmonary Hypertension Registry (JAPHR) Network Department of Cardiovascular Medicine, Shinshu University School of Medicine
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- Tatsumi Koichiro
- Japan Pulmonary Hypertension Registry (JAPHR) Network Department of Respirology, Graduate School of Medicine, Chiba University
書誌事項
- タイトル別名
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- Insights from Real-World Japanese Data
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説明
<p>Upfront combination therapy including intravenous prostaglandin I2 (PGI2-IV) is recognized as the most appropriate treatment for patients with severe pulmonary arterial hypertension (PAH). This retrospective study aimed to determine reasons why this therapy is not used for some patients with severe PAH and describe the hemodynamic and clinical prognoses of patients receiving initial combination treatment with (PGI2-IV+) or without (PGI2-IV−) PGI2-IV.</p><p>Data for patients with severe PAH (World Health Organization Functional Class III/IV and mean pulmonary arterial pressure [mPAP] ≥ 40 mmHg) were extracted from the Japan Pulmonary Hypertension Registry. Overall, 73 patients were included (PGI2-IV + n = 17; PGI2-IV− n = 56). The PGI2-IV+ cohort was younger than the PGI2-IV− cohort (33.8 ± 10.6 versus 52.6 ± 18.2 years) and had higher mPAP (58.1 ± 12.9 versus 51.8 ± 9.0 mmHg), greater prevalence of idiopathic PAH (88% versus 32%), and less prevalence of connective tissue disease-associated PAH (0% versus 29%). Hemodynamic measures, including mPAP, showed improvement in both cohorts (post-treatment median [interquartile range] 38.5 [17.0-40.0] for the PGI2-IV + cohort and 33.0 [25.0-43.0] mmHg for the PGI2-IV − cohort). Deaths (8/56) and lung transplantation (1/56) occurred only in the PGI2-IV − cohort.</p><p>These Japanese registry data indicate that older age, lower mPAP, and non-idiopathic PAH may influence clinicians against using upfront combination therapy including PGI2-IV for patients with severe PAH. Early combination therapy including PGI2-IV was associated with improved hemodynamics from baseline, but interpretation is limited by the small sample size.</p>
収録刊行物
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- International Heart Journal
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International Heart Journal 64 (4), 684-692, 2023-07-29
一般社団法人 インターナショナル・ハート・ジャーナル刊行会