viernes, 26 de julio de 2013

Riociguat for the Treatment of Chronic Thromboembolic Pulmonary Hypertension — NEJM

Riociguat for the Treatment of Chronic Thromboembolic Pulmonary Hypertension — NEJM

Original Article

Riociguat for the Treatment of Chronic Thromboembolic Pulmonary Hypertension

Hossein-Ardeschir Ghofrani, M.D., Andrea M. D'Armini, M.D., Friedrich Grimminger, M.D., Marius M. Hoeper, M.D., Pavel Jansa, M.D., Nick H. Kim, M.D., Eckhard Mayer, M.D., Gerald Simonneau, M.D., Martin R. Wilkins, M.D., Arno Fritsch, Ph.D., Dieter Neuser, M.D., Gerrit Weimann, M.D., and Chen Wang, M.D. for the CHEST-1 Study Group
N Engl J Med 2013; 369:319-329July 25, 2013DOI: 10.1056/NEJMoa1209657
Citing Articles (2)


Riociguat, a member of a new class of compounds (soluble guanylate cyclase stimulators), has been shown in previous clinical studies to be beneficial in the treatment of chronic thromboembolic pulmonary hypertension.


In this phase 3, multicenter, randomized, double-blind, placebo-controlled study, we randomly assigned 261 patients with inoperable chronic thromboembolic pulmonary hypertension or persistent or recurrent pulmonary hypertension after pulmonary endarterectomy to receive placebo or riociguat. The primary end point was the change from baseline to the end of week 16 in the distance walked in 6 minutes. Secondary end points included changes from baseline in pulmonary vascular resistance, N-terminal pro–brain natriuretic peptide (NT-proBNP) level, World Health Organization (WHO) functional class, time to clinical worsening, Borg dyspnea score, quality-of-life variables, and safety.


By week 16, the 6-minute walk distance had increased by a mean of 39 m in the riociguat group, as compared with a mean decrease of 6 m in the placebo group (least-squares mean difference, 46 m; 95% confidence interval [CI], 25 to 67; P< 0.001). Pulmonary vascular resistance decreased by 226 dyn·sec·cm–5 in the riociguat group and increased by 23 dyn·sec·cm–5 in the placebo group (least-squares mean difference, –246 dyn·sec·cm–5; 95% CI, –303 to –190; P< 0.001). Riociguat was also associated with significant improvements in the NT-proBNP level (P< 0.001) and WHO functional class (P=0.003). The most common serious adverse events were right ventricular failure (in 3% of patients in each group) and syncope (in 2% of the riociguat group and in 3% of the placebo group).


Riociguat significantly improved exercise capacity and pulmonary vascular resistance in patients with chronic thromboembolic pulmonary hypertension. (Funded by Bayer HealthCare; CHEST-1 and CHEST-2 numbers, NCT00855465 and NCT00910429, respectively.)

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