Open AccessThe achievements of the modern specific therapy of pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension: focus on the stimulator of soluble guanylate cyclase riociguat
Author(s) -
S E Gratsianskaya,
З. С. Валиева,
T V Martynyuk
Publication year - 2020
Publication title -
terapevtičeskij arhiv
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.181
H-Index - 14
eISSN - 2309-5342
pISSN - 0040-3660
DOI - 10.26442/00403660.2020.09.000717
Subject(s) - riociguat , medicine , chronic thromboembolic pulmonary hypertension , pulmonary hypertension , prostacyclin , cgmp specific phosphodiesterase type 5 , cardiology , endothelin receptor , hemodynamics , intensive care medicine , sildenafil , receptor
Currently, treatment of pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) is focused on three signaling pathways: the NO pathway, the endothelin pathway, and the prostacyclin pathway. Riociguat is the only representative of stimulators of the soluble guanylate cyclase (sGC) class that is approved for the treatment of PAH and inoperable and persistent/recurrent CTEPH. The review presents data from clinical trials showing a positive effect of riociguat on the functional and hemodynamic profile of patients with PAH and CTEPH. In recent years there has been much discussion about the possibility of optimizing therapy by switching to drugs that affect a single pathogenesis target. Thus, sGC stimulants have obvious advantages over phosphodiesterase type 5 (PDE-5) inhibitors, including the ability of riociguat to exert pharmacological effects (due to a NO-independent mechanism of action) even in conditions of reduced NO production. Switching from PDE-5 to riociguat may be safe and appropriate, according to clinical trials presented in the review. In accordance with the guidelines for the diagnosis and treatment of pulmonary hypertension of the Eurasian Association of cardiologists from 2019, this strategy is approved when PDE5 therapy is ineffective in patients with PAH FC III (WHO).