Tynan Timothy, Hird Kathryn, Hannon Tara, Gabbay Eli
1 University of Notre Dame Australia, Fremantle, WA, Australia.
2 St. John of God Hospital, Subiaco, WA, Australia.
J Int Med Res. 2019 May;47(5):2177-2186. doi: 10.1177/0300060519840130. Epub 2019 Apr 12.
To assess whether switching patients with suboptimally controlled pulmonary arterial hypertension from bosentan or ambrisentan to macitentan would improve six-minute walk test (6MWT) distance and World Health Organization functional class.
This was a retrospective cohort analysis of 37 patients from a single center. Patients were separated into three heterogeneous treatment groups and followed for 18 months: switch group (n = 14): patients switched to macitentan from bosentan/ambrisentan; added group (n = 11): patients who began macitentan as de novo therapy (n = 5) or who added macitentan to an existing sildenafil regimen (n = 6); and control group (n = 12): patients for whom sildenafil and/or bosentan/ambrisentan therapy was unchanged.
Mortality was observed in two patients (one each, switch and added groups). Patients in the control group had one hospital admission and 100% survival. There was significant improvement in functional class for the switch and added groups. Statistically significant improvement was observed in 6MWT distance in the added group alone. Overall, 92% of patients continued macitentan throughout the study.
Macitentan was well tolerated. For bosentan/ambrisentan-treated patients with suboptimally controlled pulmonary arterial hypertension, switching to macitentan may facilitate an improvement in functional class.
评估将肺动脉高压控制不佳的患者从波生坦或安立生坦换用马昔腾坦是否会改善6分钟步行试验（6MWT）距离和世界卫生组织功能分级。
这是一项对来自单一中心的37例患者进行的回顾性队列分析。患者被分为三个不同的治疗组并随访18个月：换药组（n = 14）：从波生坦/安立生坦换用马昔腾坦的患者；加用组（n = 11）：开始将马昔腾坦作为初始治疗的患者（n = 5）或在现有西地那非治疗方案基础上加用马昔腾坦的患者（n = 6）；以及对照组（n = 12）：西地那非和/或波生坦/安立生坦治疗未改变的患者。
观察到2例患者死亡（换药组和加用组各1例）。对照组有1例患者入院，生存率为百分百。换药组和加用组的功能分级有显著改善。仅加用组的6MWT距离有统计学意义的改善。总体而言，92%的患者在整个研究过程中持续使用马昔腾坦。
马昔腾坦耐受性良好。对于波生坦/安立生坦治疗的肺动脉高压控制不佳的患者，换用马昔腾坦可能有助于改善功能分级。
