Long-term outcome with intravenous iloprost in pulmonary arterial hypertension

¹ From the Department of Respiratory Medicine, Hannover Medical School, Hannover
² From the Department of Respiratory Medicine, University of Giessen Lung Center, Giessen
³ From the Department of Respiratory Medicine, University of Leipzig
⁴ From the Department of Internal Medicine I, Carl-Gustav-Carus University Dresden
⁵ From the Department of Cardiology, DRK Kliniken Berlin Köpenick, Berlin
⁶ From the Department of Cardiology and Respiratory Medicine, University of Greifswald, all in Germany

^* To whom correspondence should be addressed. E-mail: hoeper.marius{at}mh-hannover.de.

	Abstract

There is limited data on the long-term efficacy of intravenous iloprost in patients with pulmonary arterial hypertension (PAH).

This retrospective multicenter analysis evaluated the clinical course of patients with PAH treated with intravenous iloprost, in most cases after having received inhaled iloprost as first-line therapy.

Between 1997 and 2001, 79 PAH patients were treated with intravenous iloprost and followed until 2007. These patients had advanced and progressive disease as indicated by a mean pulmonary vascular resistance of 1,533 dyn·s·cm^-5 at the time of diagnosis and of 1,858 dyn·s·cm^-5 at the onset of intravenous iloprost therapy, respectively. Introduction of intravenous iloprost therapy resulted in initial hemodynamic and clinical improvement. At the end of the observation period, however, 50 (61%) patients had died and 21 (26%) required lung transplantation. Transplantation-free survival rates at 1, 3, and 5 years were 86%, 59%, and 45%, respectively, after the diagnosis of PAH, and 54%, 31%, and 15%, respectively, after the introduction of intravenous iloprost therapy. Predictors of an adverse outcome at baseline were a low 6 min walk distance and a low mixed-venous oxygen saturation.

In conclusion, despite initial hemodynamic and clinical improvement the overall long-term survival with intravenous iloprost therapy was limited.