Early selexipag initiation and long-term outcomes: insights from randomised controlled trials in pulmonary arterial hypertension
Year: 2022
Type: article
Abstract: Further understanding of when to initiate therapies in pulmonary arterial hypertension (PAH) is important to improve long-term outcomes.Post hocanalyses of GRIPHON ( NCT01106014 ) and exploratory analyses of TRITON ( NCT02558231 ) suggested benefit of early selexipag initiation on long-term outcomes, despite no additional benefitversusinitial double combination on haemodynamic and functional parameters in TRITON.Post hocanalyses investigated the effect of early selexipag initiation on disease progression and survival in a large, pooled PAH cohort. Data from newly diagnosed (≤6 months) PAH patients from GRIPHON and TRITON were pooled. Patients on active therapy with selexipag (pooled selexipag group) were compared with those on control therapy with placebo (pooled control group). Disease progression end-points were defined as per the individual studies. Hazard ratios (HR) and 95% CI for time to first disease progression event up to end of double-blind treatment (selexipag/placebo) +7 days and time to all-cause death up to end of study were estimated using Cox regression models. The pooled dataset comprised 649 patients, with 44% on double background therapy. Selexipag reduced the risk of disease progression by 52%versuscontrol (HR: 0.48; 95% CI: 0.35–0.66). HR for risk of all-cause death was 0.70 (95% CI: 0.46–1.10) for the pooled selexipagversuscontrol group. Sensitivity analyses accounting for the impact of PAH background therapy showed consistent results, confirming the appropriateness of data pooling. Thesepost hoc, pooled analyses build on previous insights, further supporting selexipag use within 6 months of diagnosis, including as part of triple therapy, to delay disease progression.
Source: ERJ Open Research
Institutions: The Royal Free Hospital, Mater Misericordiae University Hospital, University of California, Los Angeles, The University of Texas Southwestern Medical Center, Johnson & Johnson (Switzerland), Centre d’Immunologie de Marseille-Luminy, Actelion (Switzerland), Imperial College London, Medizinische Hochschule Hannover, German Center for Lung Research, Medical University of Vienna, Johns Hopkins University, University of Michigan, Université Paris-Sud, Université Paris-Saclay, Assistance Publique – Hôpitaux de Paris, Hypertension pulmonaire : physiopathologie et innovation thérapeutique, Hôpital Marie Lannelongue, Bicêtre Hospital, Hôpitaux universitaires Paris Sud, Inserm, Hôpital Paris Saint-Joseph, Cedars-Sinai Medical Center, University of Bologna
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $808
OpenAlex ID: W4308708682