RT Journal Article
SR Electronic
T1 Early selexipag initiation and long-term outcomes: insights from randomised controlled trials in pulmonary arterial hypertension
JF ERJ Open Research
JO erjor
FD European Respiratory Society
SP 00456-2022
DO 10.1183/23120541.00456-2022
VO 9
IS 1
A1 J. Gerry Coghlan
A1 Sean Gaine
A1 Richard Channick
A1 Kelly M. Chin
A1 Camille du Roure
A1 J. Simon R. Gibbs
A1 Marius M. Hoeper
A1 Irene M. Lang
A1 Stephen C. Mathai
A1 Vallerie V. McLaughlin
A1 Lada Mitchell
A1 Gérald Simonneau
A1 Olivier Sitbon
A1 Victor F. Tapson
A1 Nazzareno Galiè
YR 2023
UL http://openres.ersjournals.com/content/9/1/00456-2022.abstract
AB Further understanding of when to initiate therapies in pulmonary arterial hypertension (PAH) is important to improve long-term outcomes. Post hoc analyses of GRIPHON (NCT01106014) and exploratory analyses of TRITON (NCT02558231) suggested benefit of early selexipag initiation on long-term outcomes, despite no additional benefit versus initial double combination on haemodynamic and functional parameters in TRITON. Post hoc analyses 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% versus control (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 selexipag versus control group. Sensitivity analyses accounting for the impact of PAH background therapy showed consistent results, confirming the appropriateness of data pooling. These post 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.This post hoc pooled analysis of GRIPHON and TRITON patients with a diagnosis of ≤6 months suggests that early targeting of the prostacyclin pathway with selexipag may be beneficial in delaying disease progression in a broad PAH population https://bit.ly/3CocEBe