Sildenafil therapy in patients with sickle cell disease and pulmonary hypertension

Roberto F. Machado, Sabrina Martyr, Gregory J. Kato, Robyn J. Barst, Anastasia Anthi, Michael R. Robinson, Lori Hunter, Wynona Coles, James Nichols, Christian Hunter, Vandana Sachdev, Oswaldo Castro, Mark T. Gladwin

Research output: Contribution to journalArticle

160 Scopus citations

Abstract

Pulmonary hypertension is a frequent complication of sickle cell disease that is associated with haemolysis, impaired nitric oxide bioavailability and high mortality. We sought to evaluate the safety and efficacy of selective pulmonary vasodilators and antiproliferative agents in this at-risk population. After optimising sickle cell disease therapy to stabilise haemoglobin and fetal haemoglobin levels, we evaluated the safety and efficacy of sildenafil in 12 patients with sickle cell disease and pulmonary hypertension. Sildenafil therapy (mean duration 6 ± 1 months) decreased the estimated pulmonary artery systolic pressure [50 ± 4 to 41 ± 3 mmHg; difference 9 mmHg, 95% confidence interval (CI): 0·3-17, P = 0·043] and increased the 6-min walk distance (384 ± 30 to 462 ± 28 m; difference 78 m, 95% CI: 40-117, P = 0·0012). Transient headaches occurred in two patients and transient eye-lid oedema in four patients. No episodes of priapism occurred in the three men in the study; two of them were on chronic exchange transfusions and one had erectile dysfunction. In conclusion: (1) sickle cell disease patients with anaemia and pulmonary hypertension have significant exercise limitation; (2) the 6-min walk distance may be a valid endpoint in this population; (3) therapy with sildenafil appears safe and improves pulmonary hypertension and exercise capacity. Additional phase I studies in males with sickle cell disease followed by phase II/III placebo controlled trials evaluating the safety and efficacy of sildenafil therapy in sickle cell disease patients with pulmonary hypertension are warranted.

Original languageEnglish (US)
Pages (from-to)445-453
Number of pages9
JournalBritish journal of haematology
Volume130
Issue number3
DOIs
StatePublished - Aug 1 2005
Externally publishedYes

Keywords

  • 6-min walk test
  • Haemolysis
  • Nitric oxide
  • Phosphodiesterase 5 inhibitors
  • Pulmonary hypertension
  • Sickle cell disease

ASJC Scopus subject areas

  • Hematology

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    Machado, R. F., Martyr, S., Kato, G. J., Barst, R. J., Anthi, A., Robinson, M. R., Hunter, L., Coles, W., Nichols, J., Hunter, C., Sachdev, V., Castro, O., & Gladwin, M. T. (2005). Sildenafil therapy in patients with sickle cell disease and pulmonary hypertension. British journal of haematology, 130(3), 445-453. https://doi.org/10.1111/j.1365-2141.2005.05625.x