Background Pulmonary hypertension (PH) is a chronic disease with a high mortality rate. Therefore, choosing the right treatment at the right time is essential.
Purpose To analyse which treatments were prescribed depending on the type of disease and to analyse the treatment results and adverse effects on patients in a provincial hospital.
Material and methods Retrospective and observational study of every active patients with PH from 20 February 2002 until 1 April 2017 in the outpatients’ programme.
The following variables were collected: age, sex, PH type according to ESC/ERC-2015 guide, first treatment and its date, change of treatment and reason, first and last functional class, and days of treatment until 1 April 2017.
Data were extracted from the archives of the hospital pharmacy service, collected in an Excel table and analysed.
Results Fifty-eight patients were included: 36% (21/58)were males and 64% (37/58) were females with an average age of 69±20.4 years. The average duration of the treatment was 1,720 days (4 years and 9 months).
91.4% (53/58) patients initiated monotherapy: 39.6% (21/53) with bosentan, 32.1% (17/53) with sildenafilo, 20.8% (11/53) with ambrisentan, 5.6% (3/53) with iloprost and 1.9% (1/53) with tadalafilo.
8.6% (5/58) patients initiated combination therapy: 40% (2/5) with tadalafilo +ambrisentan, 20% (2/5) with sildenafilo +ambrisentan, 20% (2/5) with sildenafilo +iloprost and 20% (2/5) with ambrisentan +iloprost.
67.2% (39/58) patients are in monotherapy: 38.5% (15/39) with sildenafilo, 28.2% (11/39) with bosentan, 25.6% (10/39) with ambrisentan, 5.1% (2/39) with tadalafilo, 2.6% (1/39) with iloprost.
20.7% (12/58) patients in combination therapy: 25% (3/12) with tadalafilo+ambrisentan, 16.7% (2/12) with sildenafilo+ambrisentan, 16.7% (2/12) with tadalafilo+iloprost, 16.7% (2/12) with tadalafilo+bosentan, 8.3% (1/12) with sildenafilo+bosentan, 8.3% (1/12) with sildenafilo+iloprost, 8.3% (1/12) with macitentan+iloprost.
12.1% (7/58) patients in triple therapy: 42.8% (3/7) with tadalafilo+bosentan+teprostinil, 28.6% (2/7) with tadalafilo+ambrisentan+iloprost, 14.3% (1/7) with tadalafilo+bosentan+iloprost, 14.3% (1/7) with sildenafilo+bosentan+teprostinil.
Sixty-four changes of treatment occurred: 48.4% (31/64) were due to disease progression and 51.6% (33/64) due to adverse reactions. In the group of adverse reactions: 27.3% (9/33) were patients treated with sildenafilo, mainly oedema; 27.3% (9/33) with ambrisentan, mainly oedema; 27.3% (9/33) with bosentan, mainly intolerance; 6.1% (2/33) with tadalafilo, migraine and oedema; 6.1% (2/33) with sitaxentan, liver toxicity; 3% (1/33) with iloprost, oedema; and 3% (1/33) with macitentan intolerance.
Conclusion Recommendations from the ESC/ERC-2015 were followed at our hospital, based on sequential combination therapy:
91.4% patients started with monotherapy, mostly endothelin–receptor–antagonists.
Later, if it was necessary, a second drug was added, a phosphodiesterase–5–inhibitor.
If expected results were not achieved, or if patients’ conditions worsened, a third drug was added, being the main triple therapy completed with a prostaciclyn–analogous.
References and/or Acknowledgements
Sociedad Europea de Cardiologia (ESC) y la European Respiratory Society (ERS) 2015.
References and/or AcknowledgementsNo conflict of interest
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