Beraprost May Improve Cardiopulmonary and Exercise Capacity in PH-HFrEF

The addition of beraprost to the usual treatment of pulmonary hypertension due to left ventricular systolic dysfunction (PH-HFrEF) may improve cardiopulmonary hemodynamic and exercise capacity, according to a study published in Medicine. Researchers found that beraprost further decreases pulmonary artery pressure (PAP), improves left ventricular ejection fraction, and 6-minute walking distance (6MWD).

The aim of the study was to investigate the efficacy and safety of beraprost administered orally in individuals with PH-HFrEF. The investigators prospectively recruited individuals with PH-HFrEF (determined by echocardiography and right cardiac catheterization). Individuals with shock, hemorrhagic disease, severe hepatic insufficiency, acute stage myocardial infarction, malignant tumor, and other types of pulmonary hypertension were excluded. Selected individuals were given beraprost orally (1µg/kg/d) in addition to their usual treatment.

A total of 25 individuals were enrolled (17 men and 8 women) with an average age of 68.9±7.6 years. The participants were followed from January 2016 to December 2016. The 6MWD and echocardiography were performed at the beginning of the study and at 3, 6, 9, and 12 months. The occurrence of major adverse cardiac events and adverse drug reaction was recorded. These individuals had a baseline systolic PAP of 49.5±10.8 mm Hg. Systolic PAP results at 3, 6, 9, and 12 months were 39.1±8.1, 30.4±5.2, 27.7±3.0, and 27.0±4.7 mm Hg, respectively, which were all significantly lower than systolic PAP at baseline (P <.05). Baseline left ventricular ejection fraction was 34.7±9.2%, and the results at 6 months were 43.5±7.0%, at 9 months 47.0±5.5%, and at 12 months was 48.2±4.8%, which were significantly higher than at baseline (P <.05). 6MWD increased with time (282.8±80.6 m at 3 months, 367.1±81.2 m at 6 months, 389.8±87.1 m at 9 months, and 395.7±83.4 m at 12 months), and all measurements were significantly higher than baseline (190.1±75.5 m) (P <.05).

The dosage of beraprost was unchanged because there were no occurrences of adverse events related to the drug. One patient developed atrial fibrillation and recovered to sinus rhythm after intravenous administration of amiodarone. There were no instances of cardiac-related death, severe bleeding, or severe impairment of liver function, which indicated good efficacy and safety of beraprost in these individuals.

Some of the study limitations included the small sample size, which prevents the researchers from making conclusive statements. In addition, the measurements during the follow-up period obtained with echocardiography are not as accurate as right cardiac catheterization, and because this study was observational, a control group was not evaluated.

The researchers concluded that beraprost, which has beneficial effects on vessel dilatation and antiplatelet activity, was safe and effective. However, more randomized controlled studies are needed to confirm these findings.

Reference

Wang L, Zhu X, Zhao L-P, et al. Effect of beraprost on pulmonary hypertension due to left ventricular systolic dysfunction. Medicine. 2019;98(16):e14965.