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Has the 6-Min Walk Distance Run Its Course?Has the 6-Min Walk Distance Run Its Course?

Vallerie V. McLaughlin, MD, FCCP
Author and Funding Information

From the Department of Medicine, Division of Cardiovascular Medicine, University of Michigan Health System.

Correspondence to: Vallerie V. McLaughlin, MD, FCCP, Department of Medicine, University of Michigan, 1500 E Medical Center Dr, SPC 5853, Ann Arbor, MI 48109; e-mail: vmclaugh@med.umich.edu


Financial/nonfinancial disclosures: The author has reported to CHEST the following potential conflicts of interest: Dr McLaughlin has received speaking and/or consulting fees from Actelion Pharmaceuticals, Ltd; Bayer; Gilead; and United Therapeutics Corp. The University of Michigan has received funding for multicentre clinical trials from Actelion Pharmaceuticals, Ltd; Bayer; Gilead; Novartis AG; and United Therapeutics Corp.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2012;142(6):1363-1364. doi:10.1378/chest.12-1110
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Therapeutic advances in the field of pulmonary arterial hypertension (PAH) have been considerable over the past 2 decades. We now have numerous US Food and Drug Administration-approved therapies that fall into three classes: the prostanoids, the endothelin receptor antagonists, and the phosphodiesterase type 5 inhibitors. Therapies in several novel therapeutic classes are being investigated.

The prostanoids are among the most effective therapies, particularly for patients with more advanced disease. They are, however, hindered by cumbersome delivery systems requiring continuous IV infusion (epoprosentol and treprostinil), continuous subcutaneous infusion (treprostinil), or frequent interment inhalation (iloprost and treprostinil). The “holy grail” of prostanoid therapy would be an effective, well-tolerated, oral form. Beraprost is an oral prostanoid that is currently approved only in Japan. Randomized controlled trial data with beraprost are contradictory, with one trial demonstrating an improvement in 6-min walk distance (6MWD) at 12 weeks and another establishing that beraprost failed to prevent disease progression at 1 year.1,2

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