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Allopurinol in Patients with Pulmonary Hypertension Associated with Chronic Lung Disease

Authors Liu-Shiu-Cheong PSK, Lipworth BJ, Weir-McCall JR, Houston JG, Struthers AD

Received 1 May 2020

Accepted for publication 15 July 2020

Published 25 August 2020 Volume 2020:15 Pages 2015—2024


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 3

Editor who approved publication: Dr Richard Russell

Patrick SK Liu-Shiu-Cheong,1,2 Brian J Lipworth,3 Jonathan R Weir-McCall,1,4 J Graeme Houston,5 Allan D Struthers1

1Division of Molecular and Clinical Medicine, University of Dundee, Dundee DD1 9SY, UK; 2Department of Respiratory Medicine, Victoria Hospital, NHS Fife, Kirkcaldy KY2 5AH, UK; 3Scottish Centre for Respiratory Research, Medical Research Institute, University of Dundee, Dundee DD1 9SY, UK; 4Department of Radiology, University of Cambridge, Cambridge CB2 0QQ, UK; 5Imaging Science and Technology, University of Dundee, Dundee DD1 9SY, UK

Correspondence: Brian J Lipworth
Scottish Centre for Respiratory Research, Medical Research Institute, University of Dundee, Ninewells Hospital, Dundee DD1 9SY, United Kingdom
Tel +44 1382 383188

Background: Oxidative stress (OS) has been implicated in the development of pulmonary hypertension (PH) and ventricular hypertrophy. Xanthine oxidase is a well-recognised source of reactive oxygen species, which lead to OS. The aim of this proof of concept study was to assess whether allopurinol (xanthine oxidase inhibitor) would reduce right ventricular mass (RVM) in patients with PH-associated chronic lung disease (PH-CLD).
Methods: We conducted a randomised, double-blind, parallel-group, placebo-controlled trial in patients with PH-CLD (93% COPD, 7% IPF) who were randomly assigned to receive allopurinol or placebo for 12 months. The primary outcome was the mean change in RVM, as assessed by cardiac magnetic resonance imaging (CMRI). Secondary outcomes included quality of life (QOL), spirometry and six-minute walk test (6MWT).
Results: Seventy-one patients were recruited: mean age 71 years, mean pulmonary arterial pressure 30 mm Hg, FEV1 60% and resting SpO2 96%. After 12 months, there was no significant difference in the change in RVM from baseline (allopurinol 1.85g vs placebo 0.97g with mean difference 0.88g, CI − 4.77 to 3.01, p =0.7). There were also no significant changes in other cardiac parameters measured on MRI, in QOL, spirometry and 6MWT. Subgroup analysis showed that allopurinol significantly reduced RVM compared to placebo with -6.16g vs 0.75g and mean difference 6.92g (CI 1.14 to 12.69, p = 0.02) in COPD patients with more severe airflow limitation.
Conclusion: Allopurinol had no overall impact on patients with PH-CLD but had potential benefit in COPD patients with more severe airflow limitation.

Keywords: pulmonary hypertension, right ventricle, allopurinol, chronic lung disease

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