Article

Tadalafil therapy and health-related quality of life in pulmonary arterial hypertension.

Papworth Hospital, Cambridge, UK.
Current Medical Research and Opinion (impact factor: 2.38). 08/2009; 25(10):2479-85. DOI:10.1185/03007990903210066 pp.2479-85
Source: PubMed

ABSTRACT Pulmonary arterial hypertension (PAH) is a rare, progressive lung disorder that impairs performance of daily activities and quality of life (QoL), leading to right heart failure and death. Treatment options include prostanoids, endothelin antagonists, and phosphodiesterase type 5 inhibitors (e.g., tadalafil). Currently there is no cure for PAH, but tadalafil has improved exercise capacity in these patients.
To explore the effect of tadalafil on health-related quality of life (HRQoL) measures.
The Pulmonary Arterial Hypertension and Response to Tadalafil (PHIRST) clinical trial examined the efficacy and tolerability of tadalafil for the treatment of PAH. The impact of tadalafil on HRQoL and exercise capacity, as measured by 6-minute walk test (6MW test), was also examined. Change from baseline to last non-missing post-baseline was examined for the SF-36, EQ-5D, and 6MW test, along with the relationship between HRQoL and 6MW test performance.
Tadalafil 40 mg showed significant improvement over placebo for six of eight SF-36 domains, and EQ-5D index scores. Also, the tadalafil 40-mg group showed significant improvement over placebo on the 6MW test (p < 0.001), but no clear relationship was found between 6MW test performance and HRQoL.
Results suggest that tadalafil 40 mg may significantly improve HRQoL and exercise capacity for PAH patients. Limitations of this study include its relatively short nature limited to 16 weeks and the relative heterogeneity of the study population.

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    Article: The emergence of oral tadalafil as a once-daily treatment for pulmonary arterial hypertension.
    Jeremy A Falk, Kiran J Philip, Ernst R Schwarz
    [show abstract] [hide abstract]
    ABSTRACT: Pulmonary hypertension (PH) is found in a vast array of diseases, with a minority representing pulmonary arterial hypertension (PAH). Idiopathic PAH or PAH in association with other disorders has been associated with poor survival, poor exercise tolerance, progressive symptoms of dyspnea, and decreased quality of life. Left untreated, patients with PAH typically have a progressive decline in function with high morbidity ultimately leading to death. Advances in medical therapy for PAH over the past decade have made significant inroads into improved function, quality of life, and even survival in this patient population. Three classes of pulmonary artery-specific vasodilators are currently available in the United States. They include prostanoids, endothelin receptor antagonists, and phosphodiesterase type 5 (PDE5) inhibitors. In May 2009, the FDA approved tadalafil, the first once-daily PDE5 inhibitor for PAH. This review will outline the currently available data on tadalafil and its effects in patients with PAH.
    Vascular Health and Risk Management 01/2010; 6:273-80.
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Keywords

6-minute walk test
 
6MW test
 
6MW test performance
 
EQ-5D
 
EQ-5D index scores
 
exercise capacity
 
heart failure
 
HRQoL
 
impairs performance
 
last non-missing post-baseline
 
PHIRST
 
phosphodiesterase type 5 inhibitors
 
Pulmonary arterial hypertension
 
relative heterogeneity
 
SF-36 domains
 
short nature limited
 
study population
 
Tadalafil 40 mg
 
tadalafil 40-mg group
 
Treatment options
 

Joanna Pepke-Zaba