Momoi M, Hiraide T, Shinya Y, Momota H, Fukui S, Kawakami M, Itabashi Y, Fukuda K, Kataoka M.
Triple oral combination therapy with macitentan, riociguat, and selexipag for pulmonary arterial hypertension.
Ther Adv Respir Dis 2021;
15:1753466621995048. [PMID:
33627044 PMCID:
PMC7919213 DOI:
10.1177/1753466621995048]
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Abstract
Background:
The evidence regarding triple oral combination therapy for patients with
pulmonary arterial hypertension (PAH) is scarce. This study was performed to
investigate the effectiveness and safety of triple oral combination therapy
with macitentan, riociguat, and selexipag.
Methods:
Among consecutive patients with PAH who were referred to our hospital from
2009 to 2020, those who underwent triple oral combination therapy using
macitentan, riociguat, and selexipag were retrospectively analyzed.
Hemodynamic and echocardiographic assessments and Kaplan–Meier analyses of
all-cause death and initiation of prostacyclin infusion were conducted.
Results:
Twenty-six patients underwent this combination therapy. These patients were
predominantly female (73.1%) with a median age of 38 years at baseline and
nine patients were taking some PAH medications at baseline. The median time
from initiation of the first PAH drug to the third PAH drug in treatment
naïve patients was 24 days (interquartile range, 12–47 days). Four patients
(15.0%) discontinued taking any of the three vasodilators because of adverse
events, and 17 patients (65.4%) reached the maximum dose of all three drugs.
The mean pulmonary arterial pressure, pulmonary vascular resistance, and
cardiac output improved by 29%, 65%, and 82%, respectively (median
observation period: 441 days) and similar improvements were observed in
treatment-naïve patients at baseline. The survival rate and prostacyclin
infusion-free rate since administration of all three vasodilators was 93.3%
and 74.6% at 3 years, respectively. When patients were divided by risk
stratification, the prostacyclin-free rate at 3 years was 92.9% in
low-/intermediate-risk patients and 55.0% in high-risk patients.
Conclusion:
Triple oral combination therapy with macitentan, riociguat, and selexipag
sufficiently improved clinical parameters and was well tolerated in patients
with PAH. This combination could be a particularly promising strategy in
patients with low/intermediate risk and possibly even in half of patients
with high risk. Further studies are needed to validate these findings.
The reviews of this paper are available via the supplemental
material section.
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