Long-term safety and efficacy of imatinib in pulmonary arterial hypertension

Adaani E. Frost, Robyn J. Barst, Marius M. Hoeper, Hyuk Jae Chang, Robert P. Frantz, Yoshihiro Fukumoto, Nazzareno Galié, Paul M. Hassoun, Hans Klose, Hiromi Matsubara, Nicholas W. Morrell, Andrew J. Peacock, Michael Pfeifer, Gérald Simonneau, Victor F. Tapson, Fernando Torres, Carmine Dario Vizza, David Lawrence, Wei Yang, James M. FelserDeborah A. Quinn, Hossein Ardeschir Ghofrani

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Abstract

Background Imatinib is an oral inhibitor of several protein kinases implicated in the pathophysiology of pulmonary hypertension. Treatment with imatinib resulted in improved hemodynamics and exercise capacity in a controlled trial (Imatinib [QTI571] in Pulmonary Arterial Hypertension, a Randomized Efficacy Study [IMPRES]), among pulmonary arterial hypertension (PAH) patients inadequately responsive to 2 to 3 PAH-specific therapies. Methods The long-term (up to 204 weeks) safety and efficacy of imatinib in this open-label extension study were reviewed until early study termination on April 16, 2014. Of 202 IMPRES-enrolled patients, 66 imatinib and 78 placebo recipients entered the extension. Results Overall, 93.8% (135 of 144) of patients discontinued the extension study; administrative issues (i.e., sponsor termination; 32.6%) and adverse events (31.3%) were the primary reasons for discontinuation. Nine patients completed the extension study before it was terminated. Serious and unexpected adverse events were frequent. These included 6 subdural hematomas in the extension study and 17 deaths during or within 30 days of study end. Although the patients who tolerated imatinib and remained in the extension for a longer duration did experience an improvement in functional class and walk distance, most discontinued the drug and the study. Conclusions Severe adverse events, significant side effects, and a high discontinuation rate limit the utility of imatinib in the treatment of PAH. These risks outweigh any possible improvements in hemodynamics and walk distance seen in those patients able to remain on drug. The off-label use of this compound in PAH is discouraged.

Original languageEnglish
Pages (from-to)1366-1375
Number of pages10
JournalJournal of Heart and Lung Transplantation
Volume34
Issue number11
DOIs
Publication statusPublished - 2015 Nov

All Science Journal Classification (ASJC) codes

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine
  • Transplantation

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    Frost, A. E., Barst, R. J., Hoeper, M. M., Chang, H. J., Frantz, R. P., Fukumoto, Y., Galié, N., Hassoun, P. M., Klose, H., Matsubara, H., Morrell, N. W., Peacock, A. J., Pfeifer, M., Simonneau, G., Tapson, V. F., Torres, F., Dario Vizza, C., Lawrence, D., Yang, W., ... Ghofrani, H. A. (2015). Long-term safety and efficacy of imatinib in pulmonary arterial hypertension. Journal of Heart and Lung Transplantation, 34(11), 1366-1375. https://doi.org/10.1016/j.healun.2015.05.025