BETTER UNDERSTANDING PULMONARY ARTERIAL HYPERTENSION

Pulmonary arterial hypertension is a condition affecting the arteries in the lungs and right side of the heart. What are researchers at Macquarie University studying, to bring patients better treatment?


Macquarie University Hospital now has an established multidisciplinary Pulmonary Arterial Hypertension (PAH) Clinic linked to a number of related clinical trials. This patient-based approach to learning more about PAH in the private university hospital is unique in New South Wales.

Several trials are currently investigating both pharmacological and non-pharmacological approaches to improved diagnosis and treatments for PAH, giving patients attending the clinic access to additional options.

“The treatment of Pulmonary Arterial Hypertension still has many unanswered questions,” said Dr Martin Brown, Cardiologist at Macquarie University Hospital and Primary Investigator on a number of the PAH studies. “Historically, it has been under-recognised, with an average of 3.9 years delay from symptoms onset to diagnosis.

“Current treatment options are far from optimal, and many medications available internationally are not yet available or PBS funded in Australia. Our clinical trials – involving both pharmacological and non-pharmacological approaches – aim to increase options available to our patients.”

The approach to the research is multidisciplinary and includes radiologists, cardiologists, pulmonologists, rheumatologists and exercise physiologists.

“We follow an inter-collegial model,” said Dr Brown. “Our international and domestic trials involve multiple partners from across industry and other hospitals and academic units in New South Wales. These networks enable patients access to our services and to the novel treatments that come with participation in clinical research.”

WHAT ARE PAH TRIALS LOOKING AT?


The FREEDOM 310 trial is a multi-centre, international, randomised, double-blind and placebo-controlled trial that is, testing an oral treatment (treprostinil), not yet available in Australia, versus placebo as an add-on to current therapy.

The FREEDOM 311 trial is an open-label extension study of treprostinil in subjects with PAH and a long-term follow-up to Protocol FREEDOM-310, comparing oral treprostinil versus placebo three times a day for patients who are already on single background therapy.

The iNOvation trial is testing a long-established drug via a newly developed nitric oxide/inopulse® delivery device for use in long-term symptomatic subjects with PAH and in subjects with pulmonary hypertension associated with chronic obstructive pulmonary disease (COPD). This is a new international study involving 50 trial sites around the world.

A new non-pharmacological study is looking at four-dimensional blood flow dynamics in the pulmonary artery during cardiac MRI versus right heart catheterisation. The lead on this study is Professor Stuart Grieve and this is a new multi-institutional study within NSW.

A second non-pharmacological study is investigating the effects of Respiratory Muscle Training on heart function, exercise capacity and quality of life in people with PAH. This is a multi-institutional study within New South Wales led by Dr Rachel Cordina at Royal Prince Alfred Hospital.