Riociguat for the Treatment of Pulmonary Arterial Hypertension

In this trial, 443 patients with pulmonary arterial hypertension were assigned to placebo or to the soluble guanylate cyclase stimulator riociguat. At 12 weeks, riociguat significantly improved the 6-minute walk distance and pulmonary vascular resistance. Pulmonary arterial hypertension is a life-threatening disease that is characterized by increased pulmonary vascular resistance owing to progressive vascular remodeling, which can ultimately lead to right heart failure and death. 1 , 2 Current treatments include phosphodiesterase type 5 inhibitors, prostanoids, and endothelin-receptor antagonists. 1 However, mortality remains high despite treatment, 3 and there is a considerable unmet medical need in the management of this disorder. As noted elsewhere in this issue of the Journal, 4 riociguat is a member of a novel therapeutic class known as soluble guanylate cyclase stimulators. Riociguat has a dual mode of action, acting in synergy with endogenous nitric oxide . . .