Endothelin receptor antagonists for the treatment of pulmonary artery hypertension

AbstractAimsThe demonstration that endothelin production is upregulated in pulmonary artery hypertension (PAH) served as the rationale for developing endothelin-receptor antagonists (ERAs) as a treatment for PAH. This article reviews the primary studies demonstrating efficacy of ERAs in PAH.Main methodsMulticenter, placebo-controlled trials and open-label extension studies.Key findingsTwo orally active ERAs are currently approved for the treatment of PAH — the dual receptor antagonist bosentan, and the more selective ETA receptor antagonist ambrisentan-based on multicenter randomized clinical trials demonstrating efficacy and safety. Long-term experience with both agents supports maintenance of therapeutic effects in most patients. Adverse effects, including altered liver function and edema may occur and require careful monitoring.SignificanceDespite failure to demonstrate efficacy of ERAs in other cardiopulmonary conditions, ERAs have a major role in the treatment algorithm for PAH