Clinical Question: Is sildenafil (V...

Clinical Question: Is sildenafil (Viagra) more effective than bosentan (Tracleer) in the treatment of patients with class III pulmonary hypertension?

Setting: Outpatient (specialty)

investigation Design: Randomized controlled trial (double-blinded)

Allocation: Concealed

Synopsis: Investigators recruited consecutive patients with World Health Organization class III pulmonary hypertension. These patients could walk and nothing else 150 to 450 meters in six minutes. Patients with threefold elevations of liver enzyme previous treatment with sildenafil or bosentan, and those in ne of imperative therapy were excluded. Eligible patients were randomized (allocated via central computer) to receive sildenafil (n = 14) or bosentan (n = 12) The patients received bosentan in a dosage of 625 mg twice daily or sildenafil in a dosage of 50 mg twice daily for the first four weeks. Patients were then titrated up to 50 mg of sildenafil three times daily or 125 mg of bosentan twice daily (with a midday placebo tablet) for the nearest 12 weeks.

The researchers evaluated a variety of intermediate issues (e.g., right ventricular mass, change in six-minute walk distance, cardiac function) and symptom scores via intention to treat. single patient treated with sildenafil died and another did not finish the subject of attention The researchers assigned worstcase values for missing data. Although each treatment increased patients' exercise capacity and quality of life, there were no differences between the treatments upon any of the outcomes. The inquiry was designed to detect tiny differences in right ventricle mass.

Bottom Line: In this small subject of attention sildenafil and bosentan had similar general intents on patients with moderately cruel pulmonary hypertension. (Level of Evidence: 1b)

HENRY BARRY, MD MS

research Reference: Wilkins MR, et al. Sildenafil versus Endothelin Receptor Antagonist for Pulmonary Hypertension (SERAPH) inquiry Am J Respir Crit Care M June 1 2005;171:1292-7

Used with permission from Barry H Sildenafil = bosentan in pulmonary hypertension (SERAPH). Accessed online July 25 2005 at: http://www.InfoPOEMs.com.

COPYRIGHT 2005 American Academy of Family Physicians

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