Abstract
Background: Endothelin receptor antagonists are used for treatment of pulmonary arterial hypertension (PAH). However, these drugs have been associated with liver injury and patients require regular monitoring of liver function (LFT). We introduced a postal system whereby patients receiving these therapies had blood taken by their local practitioner and sent pre packaged boxes to our centre for analysis and monitoring on a monthly basis.
Aim: We audited effectiveness of this system with respect to frequency of blood sampling and compliance with accepted guidelines for monitoring of LFT derangements.
Results: Data on 181 patients aged mean 61.6 was collected with mean duration of therapy of 1.81 years representing a total of 327.61 patient years. Over this period, 2181 LFT's were performed representing an mean 6.66 samples per patient year. Of 181 patients 32.0% had ≥10 samples per year, 59.1% ≥ 8 samples per year, 72.9% ≥ 6 samples per year and 82.3% ≥ 4 samples per year. All patients had LFT's performed prior to commencing ERA therapy. Over this period 21 (11.6%) had LFT > 3 ULN and 10 (5.5%) ≥ 8 ULN. Of these patients 48.4% of patients with > 3 ULN had their ERA stopped and 19.4% of patients were re-challenged. Of 10 (5.5%) of patients with LFT> 8 ULN 3 (30%) were re-challenged with ERA. During follow up 87 patients died, of which 2 had LFT > 3 ULN. Data for LFT's was not available for 6 patients who died.
Conclusion: A novel system using pre-packaged boxes with prescribing centre laboratory monitoring and supervision by specialist nursing staff is capable of providing an acceptable level of compliance with recommended LFT monitoring.
- © 2011 ERS