Abstract:This paper provides an overview of the current state of pharmacotherapy in children with pulmonary arterial hypertension (PAH) and a brief introduction to the potentially novel pharmacologic targets for PAH. Currently, 3 classes of drugs including prostacyclin analogues, endothelin receptor antagonists and phosphodiesterase-5 inhibitors are approved for the treatment of PAH in children, which has led to improved hemodynamics, increased exercise capacity and prolonged survival. Despite these improvements, there is still a need to carry out well-designed, randomized, controlled studies with larger samples. In addition, novel drugs targeting other molecular pathways should be developed.
[1]Badesch DB, Champion HC, Sanchez MA, Hoeper MM, Loyd JE, Manes A, et al. Diagnosis and assessment of pulmonary arterial hypertension[J]. J Am Coll Cardiol, 2009, 54(1 Suppl): S55-S66.
[2]Fraisse A, Jais X, Schleich JM, di Filippo S, Maragnès P, Beghetti M, et al. Characteristics and prospective 2-year follow-up of children with pulmonary arterial hypertension in France[J]. Arch Cardiovasc Dis, 2010, 103(2): 66-74.
[3]Rich JD, Shah SJ, Swamy RS, Kamp A, Rich S. Inaccuracy of Doppler echocardiographic estimates of pulmonary artery pressures in patients with pulmonary hypertension: implications for clinical practice[J]. Chest, 2011,139(5): 988-993.
[4]McLaughlin VV, Archer SL, Badesch DB, Barst RJ, Farber HW, Lindner JR, et al. ACCF/AHA 2009 expert consensus document on pulmonary hypertension: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents and the American Heart Association: developed in collaboration with the American College of Chest Physicians, American Thoracic Society, Inc., and the Pulmonary Hypertension Association[J]. Circulation, 2009,119(16): 2250-2294.
[5]Agarwal R, Gomberg-Maitland M. Current therapeutics and practical management strategies for pulmonary arterial hypertension[J]. Am Heart J, 2011, 162(2): 201-213.
[6]Bowyer JJ, Busst CM, Denison DM, Shinebourne EA. Effect of long term oxygen treatment at home in children with pulmonary vascular disease[J]. Br Heart J, 1986, 55(4): 385-390.
[7]Barst RJ, Maislin G, Fishman AP. Vasodilator therapy for primary pulmonary hypertension in children[J]. Circulation, 1999, 99(9): 1197-1208.
[8]Barst RJ, Rubin LJ, Long WA, McGoon MD, Rich S, Badesch DB, et al. A comparison of continuous intravenous epoprostenol (prostacyclin) with conventional therapy for primary pulmonary hypertension. The Primary Pulmonary Hypertension Study Group[J]. N Engl J Med, 1996, 334(5): 296-302.
[9]Lammers AE, Hislop AA, Flynn Y, Haworth SG. Epoprostenol treatment in children with severe pulmonary hypertension[J]. Heart, 2007, 93(6): 739-743.
[11]Levy M, Celermajer DS, Bourges-Petit E, Del Cerro MJ, Bajolle F, Bonnet D. Add-on therapy with subcutaneous treprostinil for refractory pediatric pulmonary hypertension[J]. J Pediatr, 2011, 158(4): 584-588.
[12]McLaughlin VV, Benza RL, Rubin LJ, Channick RN, Voswinckel R, Tapson VF, et al. Addition of inhaled treprostinil to oral therapy for pulmonary arterial hypertension: a randomized controlled clinical trial[J]. J Am Coll Cardiol, 2010, 55(18): 1915-1922.
[13]Smadja DM, Mauge L, Gaussem P, d′Audigier C, IsraelBiet D, Celermajer DS, et al. Treprostinil increases the number and angiogenic potential of endothelial progenitor cells in children with pulmonary hypertension[J]. Angiogenesis, 2011, 14(1): 17-27.
[14]Baker SE, Hockman RH. Inhaled iloprost in pulmonary arterial hypertension[J]. Ann Pharmacother, 2005, 39(7-8): 1265-1274.
[15]Ivy DD, Doran AK, Smith KJ, Mallory GB Jr, Beghetti M, Barst RJ, et al. Short-and long-term effects of inhaled iloprost therapy in children with pulmonary arterial hypertension[J]. J Am Coll Cardiol, 2008, 51(2): 161-169.
[17]Loukanov T, Bucsenez D, Springer W, Sebening C, Rauch H, Roesch E, et al. Comparison of inhaled nitric oxide with aerosolized iloprost for treatment of pulmonary hypertension in children after cardiopulmonary bypass surgery[J]. Clin Res Cardiol, 2011,100(7): 595-602.
[18]Limsuwan A, Pienvichit P, Khowsathit P. Beraprost therapy in children with pulmonary hypertension secondary to congenital heart disease[J]. Pediatr Cardiol, 2005, 26(6): 787-791.
[19]Oyamada J, Toyono M, Shimada S, Aoki-Okazaki M, Tamura M, Takahashi T. Long-term administration of beraprost sodium for pulmonary arterial hypertension associated with congenital heart disease[J]. Intern Med, 2009, 48(17): 1531-1534.
[21]Barst RJ, Ivy D, Dingemanse J, Widlitz A, Schmitt K, Doran A, et al. Pharmacokinetics, safety, and efficacy of bosentan in pediatric patients with pulmonary arterial hypertension[J]. Clin Pharmacol Ther, 2003, 73(4): 372-382.
[22]Rosenzweig EB, Ivy DD, Widlitz A, Doran A, Claussen LR, Yung D, et al. Effects of long-term bosentan in children with pulmonary arterial hypertension[J]. J Am Coll Cardiol, 2005, 46(4): 697-704.
[23]van Loon RL, Hoendermis ES, Duffels MG, Vonk-Noordegraaf A, Mulder BJ, Hillege HL, et al. Long-term effect of bosentan in adults versus children with pulmonary arterial hypertension associated with systemic-to-pulmonary shunt: does the beneficial effect persist?[J]. Am Heart J, 2007,154(4): 776-782.
[24]Ivy DD, Rosenzweig EB, Lemarié JC, Brand M, Rosenberg D, Barst RJ. Long-term outcomes in children with pulmonary arterial hypertension treated with bosentan in realworld clinical settings[J]. Am J Cardiol, 2010, 106(9): 1332-1338.
[25]Beghetti M, Haworth SG, Bonnet D, Barst RJ, Acar P, Fraisse A, et al. Pharmacokinetic and clinical profile of a novel formulation of bosentan in children with pulmonary arterial hypertension: the FUTURE-1 study[J]. Br J Clin Pharmacol, 2009, 68(6): 948-955.
[27]Hislop AA, Moledina S, Foster H, Schulze-Neick I, Haworth SG. Long-term efficacy of bosentan in treatment of pulmonary arterial hypertension in children[J]. Eur Respir J, 2011, 38(1): 70-77.
[28]Benza RL, Barst RJ, Galie N, Frost A, Girgis RE, Highland KB, et al. Sitaxsentan for the treatment of pulmonary arterial hypertension: a 1-year, prospective, open-label observation of outcome and survival[J]. Chest, 2008, 134(4): 775-782.
[29]Barst RJ, Rich S, Widlitz A, Horn EM, McLaughlin V, McFarlin J. Clinical efficacy of sitaxsentan, an endothelin-A receptor antagonist, in patients with pulmonary arterial hypertension: open-label pilot study[J]. Chest, 2002, 121(6): 1860-1868.
[30]Blalock SE, Matulevicius S, Mitchell LC, Reimold S, Warner J, Peshock R, et al. Long-term outcomes with ambrisentan monotherapy in pulmonary arterial hypertension[J]. J Card Fail, 2010, 16(2): 121-127.
[31]Cartin-Ceba R, Swanson K, Iyer V, Wiesner RH, Krowka MJ. Safety and efficacy of ambrisentan for the treatment of portopulmonary hypertension[J]. Chest, 2011, 139(1): 109-114.
[32]Ramani GV, Park MH. Update on the clinical utility of sildenafil in the treatment of pulmonary arterial hypertension[J]. Drug Des Devel Ther, 2010, 4: 61-70.
[33]Humpl T, Reyes JT, Holtby H, Stephens D, Adatia I. Beneficial effect of oral sildenafil therapy on childhood pulmonary arterial hypertension: twelve-month clinical trial of a single-drug, open-label, pilot study[J]. Circulation, 2005,111(24): 3274-3280.
[34]Goldberg DJ, French B, McBride MG, Marino BS, Mirarchi N, Hanna BD, et al. Impact of oral sildenafil on exercise performance in children and young adults after the fontan operation: a randomized, double-blind, placebo-controlled, crossover trial[J]. Circulation, 2011,123(11): 1185-1193.
[35]Palma G, Giordano R, Russolillo V, Cioffi S, Palumbo S, Mucerino M, et al. Sildenafil therapy for pulmonary hypertension before and after pediatric congenital heart surgery[J]. Tex Heart Inst J, 2011, 38(3): 238-242.
[36]Fraisse A, Butrous G, Taylor MB, Oakes M, Dilleen M, Wessel DL. Intravenous sildenafil for postoperative pulmonary hypertension in children with congenital heart disease[J]. Intensive Care Med, 2011, 37(3): 502-509.
[41]Ishikura K, Yamada N, Ito M, Ota S, Nakamura M, Isaka N, et al. Beneficial acute effects of rho-kinase inhibitor in patients with pulmonary arterial hypertension[J]. Circ J, 2006,70(2):174-178.
[42]Fujita H, Fukumoto Y, Saji K, Sugimura K, Demachi J, Nawata J, et al. Acute vasodilator effects of inhaled fasudil, a specific Rho-kinase inhibitor, in patients with pulmonary arterial hypertension[J]. Heart Vessels, 2010, 25(2): 144-149.