Efficacy and safety of oral sildenafil in children with Down syndrome and pulmonary hypertension

Maurice Beghetti, Andrzej Rudzinski, Min Zhang, Maurice Beghetti, Andrzej Rudzinski, Min Zhang

Abstract

Background: Despite the increased risk for pulmonary hypertension in children with Down syndrome, the response to treatment with targeted therapies for pulmonary hypertension in these patients is not well characterized. The Sildenafil in Treatment-naive children, Aged 1-17 years, with pulmonary arterial hypertension (STARTS-1) trial was a dose-ranging study of the short-term efficacy and safety of oral sildenafil in children with pulmonary arterial hypertension. We assessed the safety and efficacy of oral sildenafil in children with Down syndrome and pulmonary arterial hypertension.

Methods: This was a post-hoc analysis of children with Down syndrome and pulmonary arterial hypertension enrolled in the STARTS-1 trial. Mean pulmonary arterial pressure (mPAP), pulmonary vascular resistance index (PVRI), and cardiac index (CI) were assessed at baseline and following 16 weeks of treatment with sildenafil.

Results: Of 234 patients randomized and treated in the STARTS-1 trial, 48 (20.5%) had Down syndrome. Although sildenafil produced dose-related reductions in PVRI and mPAP, compared with placebo, in non-Down syndrome patients and children developmentally able to exercise, this was not satisfactorily marked in patients with Down syndrome. The dose-related reductions in PVRI, compared with placebo, occurred in all subgroups, with the exception of the Down syndrome subgroup. Sildenafil appeared to be well tolerated in the Down syndrome subpopulation and the most frequently reported AEs were similar to those reported for the entire STARTS-1 population.

Conclusion: Sildenafil treatment for 16 weeks had no effect on PVRI or mPAP in children with Down syndrome and pulmonary arterial hypertension. The results suggest that children with Down syndrome may be less responsive to sildenafil for pulmonary arterial hypertension, but the incomplete work-up for the etiology of pulmonary arterial hypertension may have introduced a potential bias.

Trial registration: Study received, September 8, 2005 (retrospectively registered); Study start, August 2003; ClinicalTrials.gov identifier, NCT00159913 .

Keywords: Children; Down syndrome; Pulmonary hypertension; Sildenafil.

Figures

Fig. 1
Fig. 1
Changes from baseline at week 16 in a) PVRI, b) mPAP, and c) CI in DS versus non-DS patients. Treatment comparisons for pulmonary vascular resistance and cardiac index are in the form of ratios as the analyses were conducted on log transformed data. A log transformation of the week-16 data was used to achieve a normal distribution of the data. Log baseline value was included as a covariate in the analysis. DS = Down syndrome; PBO = placebo; CI = cardiac index; mPAP = mean pulmonary artery pressure; PVRI = pulmonary vascular resistance index; SIL = sildenafil

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