From the Journals

Phosphodiesterase-5 inhibitors often prescribed inappropriately


Key clinical point: Inappropriate prescribing of phosphodiesterase-5 inhibitor (PDE5i) therapy has risen 14-fold in 8 years, at a cost of $20 million per year.

Major finding: Nearly two-thirds of veterans with PH who are prescribed phosphodiesterase-5 inhibitors are receiving treatment inappropriately.

Study details: A retrospective analysis of veterans prescribed phosphodiesterase-5 inhibitors for pulmonary hypertension between 2005 and 2012.

Disclosures: The study was funded by the Department of Veterans Affairs with resources from the Edith Nourse Rogers Memorial Veterans Hospital. Elizabeth S. Klings, MD, one of the study’s authors, declared receiving research support from several pharmaceutical companies.

Source: Wiener RS et al. Ann Am Thorac Soc. 2018 Feb 27. doi: 10.1513/AnnalsATS.201710-762OC.



While most veterans with pulmonary hypertension are treated in accordance with clinical guidelines, almost two-thirds who are prescribed therapy are being treated with pulmonary vasodilators inappropriately, an analysis of veteran prescription data reveals.

Little was known about how pulmonary vasodilators were used in practice prior to the publication of this study. While pulmonary vasodilators are considered effective for group 1 pulmonary hypertension (PH), clinical guidelines and advice from the Choosing Wisely campaign recommend against their routine use for PH patients classified into the most common types of PH – groups 2 and 3 – because of a lack of benefit, potential for harm, and high cost, the authors wrote. The report was published in Annals of the American Thoracic Society.

The new analysis shows that patients with PH are potentially being exposed to unnecessary harm, according to study author Renda Soylemez Wiener, MD, MPH, of the Center for Healthcare Organization & Implementation Research at Bedford (Mass.) Veterans Affairs Medical Center, and her colleagues. Their findings also reveal that inappropriate prescribing of pulmonary vasodilators, mostly by specialist clinicians, is contributing to the financial burden of an already stretched health system.

The research team looked at prescription data for veterans prescribed a phosphodiesterase-5 inhibitor (PDE5i), which causes pulmonary vasodilation, between 2005 and 2012 at any VA site. The primary outcome of the study was the proportion of patients who received potentially inappropriate PDE5i as classified in guideline recommendations. Patients with group 1 PH were deemed to have been treated appropriately, while those with group 2 and 3 PH were deemed to have been potentially treated inappropriately. Those with groups 4 and 5 PH were thought to have received treatment of “uncertain value.”


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