Early intensive epoprostenol yields best haemodynamic outcomes in PAH

By Eleanor McDermid, Senior medwireNews Reporter

Patients with pulmonary arterial hypertension (PAH) achieve greater improvements in right heart haemodynamics if epoprostenol is given rapidly and at a high dose, research suggests.

The findings support “anecdotal evidence from PAH specialists of the merits of rapid initiation”, write Yuichi Tamura (Keio University School of Medicine, Tokyo, Japan) and study co-authors in PLoS One.

The team reviewed records of 42 epoprostenol-treated PAH patients, aged an average of 34 years, and divided them into a rapid-initiation group (19 patients), who received at least 4700 µg/kg during the first 180 days of treatment and a slow-initiation group (23 patients), who had received a lower cumulative dose.

Before starting treatment, the two groups had similar values for mean pulmonary artery pressure (mPAP), pulmonary vascular resistance (PVR) and cardiac index. But significant differences emerged at follow-up right heart catheterisation, after an average of 194 days in the rapid-initiation group and 240 days in the slow-initiation group.

For example, baseline mPAP was slightly lower in the rapid-initiation group than the slow-initiation group, at 59.9 versus 64.7 mmHg, but follow-up mPAP was significantly lower, at 44.6 versus 53.4 mmHg.

Results were similar for PVR and cardiac index; these measures improved in both groups, but follow-up values were significantly better in the rapid-initiation than slow-initiation groups, at 7.9 versus 14.4 Wood’s Units for PVR and 3.34 versus 2.43 L/min per m2 for cardiac index.

This suggests a greater improvement in haemodynamic parameters with more rapid initiation of epoprostenol, say Tamura et al.

Given that epoprostenol treatment has mortality benefits, the findings imply that rapid, high-dose initiation could maximise the survival advantage associated with the therapy, say the researchers.

They add that “analysis of a possible association between long-term mortality and the cumulative dose of epoprostenol will be needed in the future.”

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