rpcardioRational Pharmacotherapy in CardiologyРациональная Фармакотерапия в Кардиологии1819-64462225-3653«SILICEA-POLIGRAF» LLC10.20996/1819-6446-2020-04-13rpcardio-2180Research ArticleCURRENT QUESTIONS OF CLINICAL PHARMACOLOGYАКТУАЛЬНЫЕ ВОПРОСЫ КЛИНИЧЕСКОЙ ФАРМАКОЛОГИИSoluble Guanylate Cyclase Stimulators for Chronic Thromboembolic Pulmonary Hypertension Patients Treatment: New DataСтимуляторы растворимой гуанилатциклазы в терапии пациентов с хронической тромбоэмболической легочной гипертензией: новые данныеСимаковаМ. А.SimakovaM. A.

Симакова Мария Александровна – кандидат медицинских наук, старший научный сотрудник, научно-исследовательский отдел некоронарогенных заболеваний сердца

197341, Санкт-Петербург, ул. Аккуратова, 2

Maria A. Simakova – MD, PhD, Senior Researcher, Research Department of Noncoronary Heart Disease

Akkuratova ul. 2, St. Petersburg, 197341

maria.simakova@gmail.comМоисееваО. М.MoiseevaO. M.

Моисеева Ольга Михайловна – доктор медицинских наук, заведующая научно-исследовательский отдел некоронарогенных заболеваний сердца

197341, Санкт-Петербург, ул. Аккуратова, 2

Olga M. Moiseeva – MD, PhD, Professor, Head of Research Department of Noncoronary Heart Disease

Akkuratova ul. 2, St. Petersburg, 197341

Национальный медицинский исследовательский центр им. В.А. АлмазоваРоссияAlmazov Medical Research CenterRussian Federation202002052020162317323Copyright © Simakova M.A., Moiseeva O.M., 20202020Симакова М.А., Моисеева О.М.Simakova M.A., Moiseeva O.M.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.rpcardio.online/jour/article/view/2180

This narrative review describes and appraises some relatively new studies investigating the efficacy and safety profile of soluble guanylate cyclase stimulator riociguat in patients suffering from pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH). It has been a while since the publication date of pivotal CHEST-1 trial in 2013. New studies available complement existing evidence, expound on specific questions and open new frontiers for CTEPH investigations going forward. In this paper authors attempted to present data from post-hocanalysis of the CHEST-1 study and real-world data on riociguat treatment, confirming the positive effect of the drug on hemodynamic parameters of the pulmonary circulation and the functional status of patients. This effect was shown previously in large randomized trials. The extremely important positive effect of riociguat demonstrated both in the group of inoperable patients with CTEPH and in patients with residual pulmonary hypertension after pulmonary thrombendarterectomy. Of great interest are the presented some authors results of reverse remodelling of the right heart chambers during riociguat therapy in CTEPH patients, including using unique imaging methods (magnetic resonance imaging and positron emission tomography) to evaluate targeted medicinal therapy in terms of right heart remodelling. The safety profile of the drug was analyzed in the long-term post-registration international, multicenter, prospective, observational study EXPERT (NCT02092818), which confirmed the good tolerability and safety of riociguat therapy in PAH and CTEPH patients.

В настоящем обзоре представлен анализ последних публикаций, посвященных применению стимулятора растворимой гуанилатциклазы, препарата риоцигуата в лечении больных легочной артериальной гипертензией (ЛАГ) и хронической тромбоэмболической легочной гипер-тензией (ХТЭЛГ). С момента публикации регистрационного исследования CHEST-1 в 2013 г. прошло много времени, и новые работы по изучению риоцигуата при ХТЭЛГ дополняют текущие знания, уточняют частные вопросы и открывают новые горизонты изучения ХТЭЛГ в будущем. В обзоре представлены данные post hoc анализа исследования CHEST-1 и данные реальной клинической практики применения риоцигуата, подтверждающие положительное влияние препарата на показатели гемодинамики малого круга кровообращения и функциональный статус пациентов. Ранее это влияние было показано в крупных рандомизированных исследованиях. Крайне важен продемонстрированный положительный эффект риоцигаута в группе неоперабельных больных с ХТЭЛГ и у пациентов с резидуальной легочной гипертензией после выполнения тромбэндартерэктомии из легочной артерии. Большой интерес вызывают представленные результаты работ ряда авторов по изучению обратного ремоделирования правых камер сердца на фоне терапии риоцигуатом у пациентов с ХТЭЛГ, в том числе, с применением уникальных визуализирующих методов (магнитно-резонансная томография, позитронная эмиссионная томография) для оценки об-ратимости структурно-функциональных изменений правых отделов сердца. Проанализирован профиль безопасности препарата по данным длительного  пострегистрационного  международного  многоцентрового  проспективного  наблюдательного  исследования  EXPERT (NCT02092818), подтвердившего хорошую переносимость и безопасность терапии риоцигуатом у пациентов с ЛАГ и ХТЭЛГ.

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The authors declare that there are no conflicts of interest present.