Treatment of pediatric pulmonary arterial hypertension: A focus on the NO‐sGC‐cGMP pathway

• Published in: Pediatric pulmonology Vol. 54; no. 10; pp. 1516 - 1526
• Main Authors: Beghetti, Maurice, Gorenflo, Matthias, Ivy, D. Dunbar, Moledina, Shahin, Bonnet, Damien
• Format: Journal Article
• Language: English
• Published: United States John Wiley and Sons Inc 01-10-2019
• Subjects: Animals; Child; Cyclic GMP - metabolism; Humans; Nitric Oxide - metabolism; PAH; pediatrics; Pulmonary Arterial Hypertension - diagnosis; Pulmonary Arterial Hypertension - drug therapy; Pulmonary Arterial Hypertension - epidemiology; Pulmonary Arterial Hypertension - metabolism; Review; Reviews; riociguat; sGC stimulators; Soluble Guanylyl Cyclase - metabolism; sGC stimulators; PAH; pediatrics; riociguat
• ISSN: 8755-6863; 1099-0496
• DOI: 10.1002/ppul.24442

Objective
While pulmonary arterial hypertension (PAH) is rare in infants and children, it results in substantial morbidity and mortality. In recent years, prognosis has improved, coinciding with the introduction of new PAH‐targeted therapies, although much of their use in children is off‐label. Evidence to guide the treatment of children with PAH is less extensive than for adults. The goal of this review is to discuss the treatment recommendations for children with PAH, as well as the evidence supporting the use of prostanoids, endothelin receptor antagonists (ERAs), and phosphodiesterase type 5 inhibitors (PDE5i) in this setting.
Data Sources
Nonsystematic PubMed literature search and authors’ expertise.
Study Selection
Articles were selected concentrating on the nitric oxide (NO)‐soluble guanylate cyclase (sGC)‐cyclic guanosine monophosphate (cGMP) pathway in PAH. The methodology of an ongoing study evaluating the sGC stimulator riociguat in children with PAH is also described.
Results
Despite recent medical advances, improved therapeutic strategies for pediatric PAH are needed. The efficacy and tolerability of riociguat in adults with PAH have been well trialed.
Conclusion
The pooling of data across trials, supplemented by registry data, will help to confirm the safety and tolerability of prostanoids, ERAs, and PDE5i in children. Ongoing studies will clarify the place of sGC stimulators in the treatment strategy for pediatric PAH.