CHEST Guidelines-Phosphodiesterase-5-Inhibitors-Show-Promise-in-Imp

Phosphodiesterase-5-Inhibitors-Show-Promise-in-Imp

Pdf Summary

Phosphodiesterase-5 (PDE-5) inhibitors exhibit potential in improving survival for patients with chronic obstructive pulmonary disease-associated pulmonary hypertension (COPD-PH), according to recent studies. COPD is a multifactorial disease influenced by genetics, environment, and aging, which complicate associated conditions such as pulmonary hypertension. Phenotyping COPD patients with PH can be complex due to varying manifestations and overlaps with other conditions like idiopathic pulmonary arterial hypertension (PAH). <br /><br />Despite numerous trials, the effectiveness of treatments such as endothelin-1 receptor antagonists, prostacyclin pathway agents, and guanylate cyclase stimulators in COPD-PH remains unclear, with some trials like the PERFECT study being terminated due to adverse events associated with therapies. However, a study by Vitulo et al demonstrated that the PDE-5 inhibitor sildenafil significantly reduced pulmonary vascular resistance without serious adverse effects, pointing to PDE-5 inhibitors as promising for certain COPD-PH subpopulations.<br /><br />Further supporting PDE-5 inhibitors' potential, a large analysis using the Pulmonary Vascular Research Institute GoDeep Meta-Registry highlighted an increased transplantation-free survival rate among patients treated with PDE-5 inhibitors compared to untreated patients. This study, despite its positive indications, acknowledged limitations such as incomplete patient characterization and lack of certain data, stressing the need for randomized controlled trials (RCTs) to confirm efficacy.<br /><br />Current RCTs are investigating the efficacy of treatments like the inhaled soluble guanylate cyclase stimulator MK-5475 and oral PDE-5 inhibitor tadalafil, primarily measuring changes in exercise capacity. The results may further substantiate the benefits of PDE-5 inhibitors for a wider range of COPD-PH patients. Continued research is imperative to better characterize patient subgroups and develop effective treatments for COPD-PH, addressing this critical unmet medical need.

Keywords

PDE-5 inhibitors

COPD-PH

pulmonary hypertension

sildenafil

transplantation-free survival

RCTs

exercise capacity

tadalafil

Vitulo study

GoDeep Meta-Registry