Division of Pulmonary, Sleep and Critical Care Medicine, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, RI, USA.
Ther Adv Respir Dis. 2011 Dec;5(6):419-30. doi: 10.1177/1753465811411602. Epub 2011 Aug 17.
Multiple medical therapies have been developed for the treatment of pulmonary arterial hypertension (PAH) over the last decade and a half. Unfortunately, none of these medications is curative and the majority of patients develop disease progression despite treatment. Presently available medications target one of three known pathways that have been implicated in disease pathogenesis. The multiplicity of pulmonary vascular abnormalities identified in PAH provides the rationale for a therapeutic strategy that targets more than one mechanism at a time. Although a handful of studies have demonstrated clinical improvement in PAH patients who have a second medication added to stable background therapy in a randomized, placebo-controlled fashion, it is unclear whether the derived benefit is due to the combination of two therapies or merely the response to the new agent. This review discusses the rationale for combination therapy, critically reviews the findings of presently completed combination studies and outlines the need for new studies that are better designed to determine whether combination therapy is more efficacious than single agent therapies for the treatment of PAH.
在过去的十五年中，已经开发出多种医学疗法来治疗肺动脉高压（PAH）。不幸的是，这些药物都没有治愈作用，而且大多数患者尽管接受了治疗，仍会出现疾病进展。目前可用的药物针对三种已知的通路之一，这些通路与疾病发病机制有关。在 PAH 中确定的多种肺血管异常为治疗策略提供了依据，该策略可以同时针对多个机制。尽管少数研究表明，以随机、安慰剂对照的方式在稳定的背景治疗中添加第二种药物可使 PAH 患者的临床状况得到改善，但尚不清楚所获得的益处是由于两种疗法的联合还是仅仅是对新药物的反应。本文讨论了联合治疗的原理，批判性地回顾了目前已完成的联合研究结果，并概述了需要进行新的研究，以更好地确定联合治疗是否比单一药物治疗更有效治疗 PAH。
