Inhaled iloprost to treat severe pulmonary hypertension - An uncontrolled trial

Background: Inhaled aerosolized iloprost, a stable prostacyclin analogue, h as been considered a selective pulmonary vasodilator in the management of p ulmonary hypertension. Objective: To assess the efficacy of inhaled iloprost in the treatment of l ife-threatening pulmonary hypertension. Design: Open, uncontrolled, multicenter study. Setting: Intensive care units and pulmonary hypertension clinics at six uni versity hospitals in Germany. Patients: 19 patients who had progressive right-heart failure despite recei ving maximum conventional therapy (12 with primary pulmonary hypertension, 3 with pulmonary hypertension related to collagen vascular disease without lung fibrosis, and 4 with secondary pulmonary hypertension). Intervention: Inhaled iloprost, 6 to 12 times daily (50 to 200 mu g/d). Measurements: Right-heart catheterization and distance walked in 6 minutes at baseline and after 3 months of therapy. Results: During the first 3 months of therapy, New York Heart Association f unctional class improved in 8 patients and was unchanged in 7 patients. Fou r patients died, 3 of right-heartfailure and 1 of sepsis. The acute hemodyn amic response to inhaled iloprost was predominant pulmonary vasodilatation with little systemic effect at baseline and at 3 months (data available for 12 patients). Hemodynamic variables were improved at 3 months, and the dis tance walked in 6 minutes improved by 148 m (95% CI, 4.5 to 282 m; P = 0.04 8). Of the 15 patients who continued to use inhaled iloprost, 8 stopped: Fo ur had lung transplantation, 1 switched to intravenous prostacyclin therapy , and 3 died. Seven patients are still receiving inhaled iloprost (mean +/- SD) duration of therapy, 536 +/- 309 days; mean dosage, 164 +/- 38 mu g/d). Conclusions: Inhaled iloprost may offer a new therapeutic option for improv ement of hemodynamics and physical function in patients with life-threateni ng pulmonary hypertension and progressive right-heart failure that is refra ctory to conventional therapy.