Bosentan or Macitentan Therapy in Chronic Thromboembolic Pulmonary Hypertension?

Abstract

OBJECTIVE:

Research comparing bosentan and macitentan in chronic thromboembolic pulmonary hypertension (CTEPH) is scarce, although macitentan might have superior pharmacologic properties. We present the first real-world, 2-year follow-up results and compare clinical outcomes of both drugs in CTEPH.

METHODS:

All consecutive, technical inoperable or residual CTEPH patients receiving bosentan or macitentan, diagnosed in our multidisciplinary team between January 2003 and January 2019, were included. We report and compare survival, clinical worsening (CW), adverse events, WHO FC, NT-proBNP and 6-min walking test (6MWT) until 2 years after medication initiation.

RESULTS:

In total, 112 patients receiving bosentan or macitentan (58% female, mean age 62 ± 14 years, 68% WHO FC III/IV, 51% bosentan) could be included. Mean treatment duration was 1.9 ± 0.4 years for bosentan and 1.2 ± 0.6 years for macitentan. Two-year survival rate was 91% for bosentan and 80% for macitentan (HR mortality macitentan 1.85 [0.56-6.10], p = 0.31). Two-year CW-free survival was 81% and 58%, respectively (HR CW macitentan 2.16 [0.962-4.87], p = 0.06). Right atrial pressure, cardiac output (for mortality alone) and 6MWT lowest saturation were multivariate predictors at baseline. Overall adverse event rates were comparable and WHO FC, NT-proBNP and 6MWT distance improved similar for both drugs till 2-year follow-up.

CONCLUSION:

CTEPH patients receiving bosentan or macitentan have improved clinical outcomes till 2-year follow-up, without significant differences in outcomes between both therapies.

• Authors: M C J van Thor, L Ten Klooster, R J Snijder, J C Kelder, J J Mager, M C Post
• Journal: Lung (Lung) Vol. 197 Issue 6 Pg. 753-760 (12 2019) ISSN: 1432-1750 [Electronic] United States
• PMID: 31583452 (Publication Type: Comparative Study, Journal Article)

Chemical References

• Endothelin Receptor Antagonists
• Enzyme Activators
• Peptide Fragments
• Phosphodiesterase 5 Inhibitors
• Pyrazoles
• Pyrimidines
• Sulfonamides
• pro-brain natriuretic peptide (1-76)
• Natriuretic Peptide, Brain
• Sildenafil Citrate
• Bosentan
• riociguat
• macitentan

Topics

• Aged
• Bosentan (therapeutic use)
• Chronic Disease
• Drug Therapy, Combination
• Endarterectomy
• Endothelin Receptor Antagonists (therapeutic use)
• Enzyme Activators (therapeutic use)
• Female
• Humans
• Hypertension, Pulmonary (drug therapy, etiology, physiopathology)
• Male
• Middle Aged
• Natriuretic Peptide, Brain (metabolism)
• Peptide Fragments (metabolism)
• Phosphodiesterase 5 Inhibitors (therapeutic use)
• Pulmonary Embolism (complications, drug therapy, physiopathology)
• Pyrazoles (therapeutic use)
• Pyrimidines (therapeutic use)
• Retrospective Studies
• Sildenafil Citrate (therapeutic use)
• Sulfonamides (therapeutic use)
• Survival Rate
• Walk Test