Medikamenten-induzierte pulmonale Hypertonie – eine aktuelle Übersicht

Zusammenfassung

Hintergrund: Die pulmonale Hypertonie (PH) wird nach der gegenwärtig gültigen Klassifikation in fünf Gruppen unterteilt. Zur Gruppe 1 zählt die Medikamenten-assoziierte pulmonal-arterielle Hypertonie (PAH) als eigenständige Form. Die vorliegende Arbeit gibt einen aktuellen Kenntnisstand über Medikamente, die mit der Entstehung einer PAH oder einer pulmonal veno-okklusiven Erkrankung (PVOD), einer Untergruppe der PAH, in Verbindung gebracht werden.

Methode: Es erfolgte eine selektive Literaturrecherche im Zeitraum von 1960 bis 2015 in Pubmed. Die verwendeten Suchbegriffe waren pulmonary hypertension, pulmonary arterial hypertension, pulmonary veno-occlusive disease, drug induced pulmonary hypertension und chemotherapy induced PVOD. Hauptsächlich deutsche, englische und französische Publikationen zu diesem Thema wurden berücksichtigt.

Ergebnisse: Ein Zusammenhang zwischen der Einnahme von Medikamenten und der Entstehung einer PH wurde für verschiedene Medikamente oder Substanzklassen, vor allem Appetitzügler und Interferone, aber auch für einzelne Chemotherapeutika beschrieben.

Schlussfolgerung: Viele Publikationen bezüglich der Medikamenten-induzierten PH beziehen sich auf Einzelfallberichte oder kleine Patientenkohorten. Die Medikamenten-induzierte PH ist in den vergangenen Jahren zunehmend in den Mittelpunkt gerückt und bedarf weiterer Aufklärung. Eine enge Zusammenarbeit zwischen niedergelassenen Medizinern, PH-Kompetenzzentren und Zulassungsbehörden ist daher umso bedeutsamer, um weitere potenzielle Präparate, die im Zusammenhang mit einer Arzneimittel-induzierten pulmonalen Hypertonie stehen könnten, frühzeitig zu identifizieren. Für den klinischen Alltag ist vor dem Hintergrund dieser Erkenntnisse eine gezielte Medikamentenanamnese obligat.

Abstract

Background: The current classification of pulmonary Hypertension (PH) consists of five clinical groups, and drug-induced pulmonary arterial hypertension (PAH) is classified under Group 1 as a distinct entity. Our present work encompasses the available data concerning the association between the intake of a wide range of drugs and development of PAH.

Methods: A selective literature search was performed in Pubmed to include published work between the years 1960 – 2015. For this search, the terms pulmonary hypertension, pulmonary arterial hypertension, pulmonary veno-occlusive disease, drug induced pulmonary hypertension and chemotherapy induced PVOD were used. Mainly German, English and French publications regarding this topic were considered.

Results: An association between drug intake and PH development was described for different medications, among them appetite-suppressant drugs, interferon alpha and beta, but also several chemotherapeutic drugs.

Conclusions: The present literature regarding drug-induced PH mainly comprises case reports and small patient cohorts. Drug-induced PH has become increasingly discussed in recent years and needs further elucidation. A close cooperation between clinicians, PH expert centers and regulatory agencies is mandatory to identify other potential drugs at an early stage that may be linked to PH development. For the clinician, a thorough patient interview including drug history is necessary in the evaluation of a patient with PH.

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