Vidyya Medical News Service
Volume 6 Issue 336 Published - 14:00 UTC 08:00 EST 1-Dec-2004 Next Update - 14:00 UTC 08:00 EST 2-Dec-2004
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New treatment offers marked improvement in deadly pulmonary arterial hypertension

Researchers showed that 16 weeks of treatment with the oral drug bosentan led to marked improvement in all clinical and hemodynamic parameters of the deadly disease severe pulmonary arterial hypertension (PAH).

This illness is often associated with human immunodeficiency virus (HIV) infection. The new drug is an oral, dual endothelin receptor antagonist. In HIV, endothelin is believed to be produced excessively, causing vasoconstriction, cell proliferation, fibrosis, and inflammation.

PAH results from chronic obstruction of small pulmonary arteries due in part to endothelial and vascular smooth muscle dysfunction and proliferation.

In most cases, earlier death occurs as a direct result of PAH. The authors said that, as a result of the bosentan treatment, significant improvements were reported for parameters considered prognostic indicators of survival in the disease. These indicators included 6-minute walk distance, cardiac index, pulmonary vascular resistance, and improved echocardiography parameters.

All patients suffered at least one adverse side effect of bosentan treatment, including peripheral edema, headache, abnormal liver function, muscle cramps, fluid retention, and vomiting.

Although 15 of the 16 patients were taking hepatotoxic antiretroviral therapies and 4 patients were co-infected with chronic hepatitis B and C, only 2 or 16 were believed to have abnormal hepatic function, which the investigators considered to be within the range of prior experience.

The study is published in the first issue for December 2004 of the American Journal of Respiratory and Critical Care Medicine.

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