Journal
CHEST
Volume 143, Issue 6, Pages 1699-1708Publisher
AMER COLL CHEST PHYSICIANS
DOI: 10.1378/chest.12-1594
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Funding
- National Institutes of Health/National Heart, Lung and Blood Institute [K23 HL093351, U10HL080509, U10HL80413, U10HL80274, U10HL80370, U10HL80371, U10HL80383, U10HL80411, U10HL80509, U10HL80510, U10HL80513, U10HL80543, U10HL80571, U10HL80685]
- Chicago Community Trust
- National Institutes of Health
- InterMune
- Janssen Biotech Inc
- Actelion Pharmaceuticals, Ltd
- Janssen Biotech, Inc
- Forest Pharmaceuticals, Inc
- GlaxoSmithKline plc
- Gilead
- Mpex
- Takeda Pharmaceuticals International GmbH
- American College of Chest Physicians
- American Lung Association
- AstraZeneca
- Bayer AG
- William Beaumont Hospital
- Boehringer Ingelheim GmbH
- Center for Health Care Education
- CME Incite
- Forest Pharmaceuticals
- France Foundation
- Lovelace Health System
- MedEd
- MedScape/WebMD LLC
- National Association for Continuing Education Inc.
- CME Networks, LLC
- Projects in Knowledge, Inc
- St Luke's Health System
- University of Illinois at Chicago College of Medicine
- University of Texas Southwestern
- University of Virginia
- UpToDate, Inc.
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Background: Idiopathic pulmonary fibrosis (IPF) is a progressive lung disease with pulmonary vasculopathy. Objective: The purpose of this study was to determine whether sildenafil improves 6-min walk distance (6MWD) in subjects with IPF and right ventricular dysfunction. Methods: The IPFnet, a network of IPF research centers in the United States, Conducted a randomized trial examining the effect of sildenafil on 6MWD in patients with advanced IPF, defined by carbon monoxide diffusing capacity <35% predicted. A substudy examined 119 of 180 randomized subjects where echocardiograms were available for independent review by two cardiologists. Right ventricular (RV) hypertrophy (RVH), right ventricular systolic dysfunction (RVSD), and right ventricular systolic pressure (RVSP) were assessed. Multivariable linear regression models estimated the relationship between RV abnormality, sildenafil treatment, and changes in 6MWD, St. George's Respiratory Questionnaire (SGRQ), the EuroQol instrument, and SF-36 Health Survey (SF-36) from enrollment to 12 weeks. Results: The prevalence of RVH and RVSD were 12.8% and 18.6%, respectively. RVSP was measurable in 71 of 119 (60%) subjects; mean RVSP was 42.5 mm Hg. In the subgroup of subjects with RVSD, subjects treated with sildenafil experienced less decrement in 6MWD (99.3 m; P = .01) and greater improvement in SGRQ (13.4 points; P = .005) and EuroQol visual analog scores (17.9 points; P = .04) than subjects receiving placebo. In the subgroup with RVH, sildenafil was not associated with change in 6MWD (P = .13), but was associated with greater relative improvement in SGRQ (14.8 points; P = .02) vs subjects receiving placebo. Sildenafil treatment in those with RVSD and RVH was not associated with change in SF-36. Conclusions: Sildenafil treatment in IPF with RVSD results in better preservation of exercise capacity as compared with placebo. Sildenafil also improves quality of life in subjects with RVH and RVSD.
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