Can we prescribe sildenafil for pulmonary hypertension due to COPD ?
Posted Oct 04 2011 1:05pm
Sildenafil was first approved for pulmonary hypertension in 2006 after a much hyped study called “SUPER” published in New England journal of medicine.
This study population included only idiopathic pulmonary hypertension and secondary pulmonary hypertension due to pulmonary vascular disease like scleroderma etc .The exclusion criteria were not clearly described in this paper , but it was clear PAH due to COPD was not included.
Please note , the title and conclusion are misleading .The real conclusion should be read as sildenefail may be useful some of the patients with in idiopathic PAH and secondary PAH sue to connective tissue disorders.
Further , the conclusion of SUPER study gave considerable room for misinterpretation (Intentional ? ) .The term PAH was used in too casual and generalised manner. Many of the physicians started using sildenafil for every case of PAH including COPD.
COPD is a disorder of airway , while sildenafil is a drug which acts on the vascular system (Vascular smooth muscle ) Apply your own logic ,how effective sildenafil would be in COPD patients .
As on today there is no good evidence to suggest sildenafil will be useful in COPD. (Few studies suggested it may be useful in fibrosed lung)
Still , no body can prevent a physician from testing this drug in otherwise refractory COPD as we have a convenient semantics called ” off label indication “
So, the answer to the title question still eludes the majority . . . even though many of us know the answer !
Ans : You can use it . . . but your patient may not really benefit , of course it satisfies the physician and the drug company.
An editorial from Indian journal of chest diseases debates the issue