Markus Wehland

A Focus on Riociguat in the Treatment of Pulmonary Arterial Hypertension

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaperReviewResearchpeer-review


  • Anne Kathrine Toxvig
  • ,
  • Markus Wehland
  • Daniela Grimm
  • Manfred Infanger, Otto von Guericke University Magdeburg
  • ,
  • Marcus Krüger, Otto von Guericke University Magdeburg

Current treatment of pulmonary arterial hypertension (PAH) targets three signalling pathways: the nitric oxide (NO) pathway, the endothelin pathway and the prostacyclin pathway. Riociguat is a soluble guanylate cyclase stimulator, acting via the NO pathway in a new way: Unlike other common drugs targeting this pathway (e.g. tadalafil and sildenafil), riociguat acts independently of endogenous NO. This MiniReview focuses on PAH treatment with riociguat and on its advantages and disadvantages compared to other drugs targeting the NO pathway. In the PATENT-1 trial (NCT00810693), riociguat improved significantly the 6-minute walking distance in patients suffering from PAH, with a mean difference (MD) of 36 m compared to a placebo group. The results are comparable to those found for its competitors tadalafil (MD of 33 m) and sildenafil (MD of 50 m) in the PHIRST-1 trial (NCT00125918) and the SUPER-1 trial (NCT00644605). No obvious advantages were found regarding pharmacokinetic features and adverse events. In the RESPITE study (NCT02007629), patients with PAH with insufficient response to treatment with tadalafil or sildenafil were switched to riociguat. These results indicate that riociguat might be superior regarding efficacy to PDE-5 inhibitors in a patient group, where endogenous NO production might be insufficient. This finding was further examined in the REPLACE study (NCT02891850). Moreover, riociguat has shown promising anti-proliferative, anti-inflammatory and anti-fibrotic effects in animal models. Further investigations are needed to determine if this applies also to humans. Taken together, riociguat induces vasodilation of the pulmonary arteries and leads to an improvement in the ability to carry out physical activity. This article is protected by copyright. All rights reserved.

Original languageEnglish
Book seriesBasic & Clinical Pharmacology & Toxicology
Pages (from-to)202-214
Number of pages13
Publication statusPublished - Sep 2019

Bibliographical note

This article is protected by copyright. All rights reserved.

    Research areas

  • PAH, blood pressure, clinical trials, guanylate cyclase stimulator, nitric oxide pathway

See relations at Aarhus University Citationformats

ID: 156676457