Brief Report: Effect of ambrisentan treatment on exercise-induced pulmonary hypertension in systemic sclerosis: A prospective single-center, open-label pilot study

Authors

  • Rajeev Saggar,

    1. Heart-Lung Institute, St. Joseph Hospital and Medical Center, Phoenix, Arizona
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    • Drs. Rajeev Saggar and Khanna contributed equally to this work.

    • Dr. Rajeev Saggar has received consulting fees, speaking fees, and/or honoraria from Gilead Sciences, Actelion, and United Therapeutics (less than $10,000 each).

  • D. Khanna,

    1. University of Michigan, Ann Arbor
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    • Drs. Rajeev Saggar and Khanna contributed equally to this work.

    • Dr. Khanna has received consulting fees, speaking fees, and/or honoraria from Pfizer, United Therapeutics, Gilead Sciences, and Actelion (less than $10,000 each).

  • S. Shapiro,

    1. David Geffen School of Medicine, University of California, Los Angeles
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    • Dr. Shapiro has received consulting fees, speaking fees, and/or honoraria from United Therapeutics, Gilead Sciences, Actelion, and Novartis (less than $10,000 each).

  • D. E. Furst,

    1. David Geffen School of Medicine, University of California, Los Angeles
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    • Dr. Furst has received consulting fees, speaking fees, and/or honoraria from UCB, Actelion, Bristol-Myers Squibb, Amgen, Biogen Idec, Centocor, Gilead Sciences, GlaxoSmithKline, Novartis, Pfizer, Roche, and Genentech (less than $10,000 each).

  • P. Maranian,

    1. David Geffen School of Medicine, University of California, Los Angeles
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  • P. Clements,

    1. David Geffen School of Medicine, University of California, Los Angeles
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    • Dr. Clements has received consulting fees, speaking fees, and/or honoraria from Gilead Sciences (less than $10,000).

  • F. Abtin,

    1. David Geffen School of Medicine, University of California, Los Angeles
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  • Shiv Dua,

    1. George Washington University, Washington, DC
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  • J. Belperio,

    1. David Geffen School of Medicine, University of California, Los Angeles
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  • Rajan Saggar

    Corresponding author
    1. David Geffen School of Medicine, University of California, Los Angeles
    • Heart-Lung Institute, St. Joseph Hospital and Medical Center, 500 West Thomas Road, Suite 500, Phoenix, AZ 85013
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    • Dr. Rajan Saggar has received consulting fees, speaking fees, and/or honoraria from Actelion and Gilead Sciences (less than $10,000 each).


  • ClinicalTrials.gov identifier: NCT01051960.

Abstract

Objective

Exercise-induced pulmonary hypertension (ePH) may represent an early, clinically relevant phase in the spectrum of pulmonary vascular disease. The purpose of this pilot study was to describe the changes in hemodynamics and exercise capacity in patients with systemic sclerosis (SSc) spectrum–associated ePH treated with open-label daily ambrisentan.

Methods

Patients were treated with ambrisentan, 5 mg or 10 mg once daily, for 24 weeks. At baseline and 24 weeks, patients with SSc spectrum disorders exercised in a supine position, on a lower extremity cycle ergometer. All patients had normal hemodynamics at rest. We defined baseline ePH as a mean pulmonary artery pressure of >30 mm Hg with maximum exercise and a transpulmonary gradient (TPG) of >15 mm Hg. The primary end point was change in pulmonary vascular resistance (PVR) with exercise. Secondary end points included an improvement from baseline in 6-minute walking distance, health-related quality of life assessments, and cardiopulmonary hemodynamics.

Results

Of the 12 enrolled patients, 11 completed the study. At 24 weeks there were improvements in mean exercise PVR (85.8 dynes × second/cm5; P = 0.003) and mean distance covered during 6-minute walk (44.5 meters; P = 0.0007). Improvements were also observed in mean exercise cardiac output (1.4 liters/minute; P = 0.006), mean pulmonary artery pressure (−4.1 mm Hg; P = 0.02), and total pulmonary resistance (−93.0 dynes × seconds/cm5; P = 0.0008). Three patients developed resting pulmonary arterial hypertension during the 24 weeks.

Conclusion

Exercise hemodynamics and exercise capacity in patients with SSc spectrum–associated ePH improved over 24 weeks with exposure to ambrisentan. Placebo-controlled studies are needed to confirm whether this is a drug-related effect and to determine optimal therapeutic regimens for patients with ePH.

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