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Copyright ©ERS Journals Ltd 2005
Bosentan therapy for portopulmonary hypertension
1 Dept of Respiratory Medicine, Hanover Medical School, Hanover, 2 Dept of Respiratory Medicine, Carl Gustav Carus University of Dresden, Dresden, and 3 Dept of Respiratory Medicine, University of Leipzig, Leipzig, Germany
CORRESPONDENCE: M. M. Hoeper, Dept of Respiratory Medicine, Hannover Medical School, 30623 Hannover, Germany. Fax: 49 5115328536. E-mail: hoeper.marius@mh-hannover.de
Keywords: Cirrhosis, endothelin receptor antagonists, secondary pulmonary hypertension
Received: July 5, 2004
Accepted October 15, 2004
The dual endothelin receptor antagonist bosentan has been approved in several countries for pulmonary arterial hypertension, and patients with portopulmonary hypertension (PPHTN) have not specifically been excluded. However, no data have been published on the efficacy and safety of bosentan in this patient population. Here, the first clinical experiences with bosentan in patients with Child A cirrhosis and severe PPHTN are reported.
In total, 11 consecutive patients with cirrhosis and severe PPHTN in New York Heart Association Functional Classes III and IV were treated for >1 yr with bosentan.
After 1 yr of treatment with bosentan, all patients showed improved symptoms and exercise capacity. The 6-min walking distance increased from 310±102 m at baseline to 388±81 m at 1 yr. Cardiopulmonary exercise testing disclosed a significant increase in peak oxygen uptake, from 12.6±3.5 to 16.6±2.8 mL·min–1·kg–1. Pulmonary vascular resistance fell from 944±519 to 635±321 dynes·s·L–1. The medication was well tolerated by all patients, and there was no evidence of drug-related liver injury.
In conclusion, bosentan proved to be efficacious and safe in a small number of patients with portopulmonary hypertension.
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