Dr Simon Gibbs Discusses the Future of Pulmonary Hypertension Treatments
Current drugs for pulmonary hypertension treat 3 pathways, but currently there aren't any new drugs to treat different pathways, although there likely will be some in the future, said Simon Gibbs, MD, Reader in Pulmonary Hypertension at the National Heart and Lung Institute, Imperial College London.
Transcript (slightly modified) What are the latest findings and advances in pulmonary hypertension treatment?
Well the first thing to say about the drugs is that the drugs treat 3 pathways. The prostacyclin pathway, the nitric oxide pathway, and the endothelium pathway. There have been, and there will be, I’m sure, new drugs within these pathways.
What we don’t have at the present time are new drugs, which are going into phase 3 trials in different pathways. Attempts, of course, have been made with those—particularly to look for drugs which are antiproliferative agents, as we saw with imatinib, for example. But as yet, we do not have drugs that are effective in phase 3 trials in any other pathway. I’m sure they will turn up in the future, there’s a long list—huge list—of potential agents. The challenge, of course, with the potential agents is that animal models respond to these agents, but there’s not a good animal model of the human pulmonary circulation and it doesn’t predict what happens in man.
So, the big changes, really have been changing the strategy of how we use the 3 pathways, and that comes down to starting with combination therapy, and using initial combination therapy, and that’s been an important breakthrough—both initial and sequential combination therapy. In other words, not waiting until the patient deteriorates, but getting them on a full range drug therapies before that situation can arise, because we can delay it and obtain better outcomes with that.
I think that is probably the most important thing—to get strategy right—and then having a risk assessment, which is part of the follow-up of patients, to assess their risk using different measurements—because there is no measurement that predicts the outcome in this disease; you have to use a range of things—and apply those to the risk to determine when to increase treatment or add another drug. That’s probably the most important things that happened; as I said, there will be other drugs in the future, but there’s nothing immediately on the horizon.