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Efficacy and safety of bosentan for pulmonary arterial hypertension in adults with congenital heart disease.

Abstract
The dual endothelin receptor antagonist, bosentan, has been shown to be well tolerated and effective in improving pulmonary arterial hypertension (PAH) symptoms in patients with Eisenmenger syndrome but data from longer-term studies are lacking. The aim of this study was to retrospectively analyze the long-term efficacy and safety of bosentan in adults with PAH secondary to congenital heart disease (PAH-CHD). Prospectively collected data from adult patients with PAH-CHD (with and without Down syndrome) initiated on bosentan from October 2007 through June 2010 were analyzed. Parameters measured before bosentan initiation (62.5 mg 2 times/day for 4 weeks titrated to 125 mg 2 times/day) and at each follow-up (1 month and 3, 6, 9, 12, 18, and 24 months) included exercise capacity (6-minute walk distance [6MWD]), pretest oxygen saturation, liver enzymes, and hemoglobin. Data were analyzed from 39 patients with PAH-CHD (10 with Down syndrome) who had received ≥ 1 dose of bosentan (mean duration of therapy 2.1 ± 1.5 years). A significant (p < 0.0001) average improvement in 6MWD of 54 m over a 2-year period in patients with PAH-CHD without Down syndrome was observed. Men patients had a 6MWD of 33 m greater than women (p < 0.01). In all patients, oxygen saturation, liver enzymes, and hemoglobin levels remained stable. There were no discontinuations from bosentan owing to adverse events. In conclusion, patients with PAH-CHD without Down syndrome gain long-term symptomatic benefits in exercise capacity after bosentan treatment. Men seem to benefit more on bosentan treatment. Bosentan appears to be well tolerated in patients with PAH-CHD with or without Down syndrome.
AuthorsOliver Monfredi, Linda Griffiths, Bernard Clarke, Vaikom S Mahadevan
JournalThe American journal of cardiology (Am J Cardiol) Vol. 108 Issue 10 Pg. 1483-8 (Nov 15 2011) ISSN: 1879-1913 [Electronic] United States
PMID21943933 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
CopyrightCopyright © 2011 Elsevier Inc. All rights reserved.
Chemical References
  • Antihypertensive Agents
  • Hemoglobins
  • Sulfonamides
  • Aspartate Aminotransferases
  • Alanine Transaminase
  • bosentan
  • Oxygen
Topics
  • Adult
  • Aged
  • Alanine Transaminase (blood)
  • Antihypertensive Agents (therapeutic use)
  • Aspartate Aminotransferases (blood)
  • Down Syndrome (epidemiology)
  • Exercise Tolerance
  • Female
  • Heart Defects, Congenital (epidemiology)
  • Hemoglobins (analysis)
  • Humans
  • Hypertension, Pulmonary (drug therapy)
  • Male
  • Middle Aged
  • Oxygen (blood)
  • Retrospective Studies
  • Sex Factors
  • Sulfonamides (therapeutic use)

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