Pulmonary vasodilator therapy in sarcoidosis-associated pulmonary hypertension may decrease lung function decline and mortality

Shameek Gayen; Sohaib Ansari; Bilal H Lashari; Huaqing Zhao; Gerard J Criner; Rohit Gupta; Albert James Mamary

doi:10.1002/pul2.12245

Pulmonary vasodilator therapy in sarcoidosis-associated pulmonary hypertension may decrease lung function decline and mortality

Pulm Circ. 2023 Jun 5;13(2):e12245. doi: 10.1002/pul2.12245. eCollection 2023 Apr.

Authors

Shameek Gayen¹, Sohaib Ansari¹, Bilal H Lashari¹, Huaqing Zhao², Gerard J Criner¹, Rohit Gupta¹, Albert James Mamary¹

Affiliations

¹ Department of Thoracic Medicine and Surgery Lewis Katz School of Medicine at Temple University of Hospital Philadelphia Pennsylvania USA.
² Center for Biostatistics and Epidemiology Lewis Katz School of Medicine at Temple University Hospital Philadelphia Pennsylvania USA.

Abstract

The efficacy of treating sarcoidosis-associated pulmonary hypertension (SAPH) with pulmonary vasodilator therapy is unclear. The INCREASE trial showed improvement in 6-minute walk distance (6MWD) and in decline in functional vital capacity (FVC) in patients with interstitial lung disease and pulmonary hypertension. We hypothesize that patients with SAPH treated with pulmonary vasodilators have reduced decline in FVC. We retrospectively analyzed patients with SAPH who underwent lung transplantation evaluation. The primary objective was to compare change in FVC between patients with SAPH who received pulmonary vasodilators (treated) and those who did not (untreated). Secondary objectives were to compare the change in 6MWD, change in oxygen requirement, transplant rates, and mortality between treated and untreated SAPH patients. We identified 58 patients with SAPH; 38 patients received pulmonary vasodilator therapy, and 20 patients did not. Treated SAPH patients had significantly less decline in FVC than untreated SAPH patients (+54 mL vs. -357 mL, p < 0.01). Treated SAPH patients had significantly higher survival than untreated SAPH patients. Receiving PH therapy was significantly associated with a change in FVC (estimate 0.36 ± 0.07, p < 0.01) and decreased mortality (hazard ratio 0.29, confidence interval 0.12-0.67, p < 0.01). Among patients with SAPH, those who received pulmonary vasodilator therapy had significantly less decline in FVC and increased survival. Receiving pulmonary vasodilator therapy was significantly associated with FVC change and decreased mortality. These study findings point towards potential benefit of pulmonary vasodilator therapy in SAPH patients. Further prospective studies are required to fully elucidate the benefits of pulmonary vasodilator therapy in SAPH.

Keywords: functional vital capacity; lung transplant; pulmonary hypertension; pulmonary vasodilator therapy; sarcoidosis.