Institute of Cardiology, University of Bologna, Italy.
Eur Respir Rev. 2009 Sep;18(113):148-53. doi: 10.1183/09059180.00003809.
There is a strong clinical rationale for combination therapy in pulmonary arterial hypertension (PAH), as several pathological pathways have been implicated in its pathogenesis and no single agent has yet been shown to deliver completely satisfactory results. Registry data indicate that use of combination therapy is in fact common in existing clinical practice, even though support has been largely empirical or derived from small-scale observational studies. Data from large, adequately powered, randomised controlled trials of combination therapy in PAH are now emerging and suggest that combination therapy may be clinically beneficial. Studies of bosentan in combination with prostanoids and phosphodiesterase (PDE)-5 inhibitors show consistent evidence of improvements in exercise capacity compared with placebo. Similar improvements have been observed with PDE-5 inhibitors in combination with prostanoids. The appropriate timing of combination therapy requires further evaluation but goal-oriented therapy using combinations of oral and inhaled drugs has been shown to provide acceptable long-term results in patients with advanced PAH. Monitoring should be performed regularly and be based on repeatable, noninvasive, measurable parameters that have prognostic value.
在肺动脉高压 (PAH) 中，联合治疗具有很强的临床理论基础，因为有几个病理途径与它的发病机制有关，而且还没有一种单一的药物能够完全令人满意的结果。登记数据表明，联合治疗实际上在现有的临床实践中很常见，尽管支持主要是基于经验或来自小规模观察性研究。现在正在出现关于 PAH 联合治疗的大型、充分有力的随机对照试验数据，表明联合治疗可能具有临床益处。波生坦联合前列腺素和磷酸二酯酶 (PDE)-5 抑制剂的研究显示，与安慰剂相比，运动能力有一致的改善证据。前列腺素联合 PDE-5 抑制剂也观察到了类似的改善。联合治疗的适当时机需要进一步评估，但使用口服和吸入药物联合的目标导向治疗已经在晚期 PAH 患者中提供了可接受的长期结果。监测应定期进行，并基于具有预后价值的可重复、非侵入性、可测量的参数。
