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Zhao J, Wang M, Yu Q, Yang Y, Zhang B, Zhan S. A real-world analysis of safety profile of selexipag by using FDA adverse Event Reporting System (FAERS). Expert Opin Drug Saf 2024; 23:937-948. [PMID: 38032065 DOI: 10.1080/14740338.2023.2290633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 10/31/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND The current investigation sought to conduct a real-world analysis of adverse events (AEs) associated with selexipag by utilizing data from the Food and Drug Administration Adverse Event Reporting System (FAERS). METHODS The Reporting Odds Ratios (ROR) and the Medicines Healthcare Products Regulatory Agency (MHRA) method were employed to assess the potential associations between selexipag and AEs. Case reports of adverse drug reaction (ADR) related to selexipag were systematically sourced from PubMed, Embase, and Web of Science databases. RESULTS Our analysis identified 281 Preferred Terms (PTs) signals across 20 System Organ Classes (SOCs) were found to meet the screening threshold. The most common AEs were consistent with instructions, randomized controlled trials (RCTs), and case reports. Of significant note, unexpected AEs principally target SOCs of infections and infestations, blood and lymphatic system, renal and urinary disorders, hepatobiliary disorders, including pneumonia, metapneumovirus, decreased hemoglobin. transfusion, iron-deficiency anemia, dialysis hypotension, abnormal creatinine renal clearance, liver function test increased, hepatic function abnormal, hepatic enzyme increased. Within the pediatric population, unexpected signals such as pyrexia, pneumonia, and intussusception necessitate special precautionary measures. CONCLUSIONS The findings contribute valuable insights to clinical practice, reinforcing the importance of vigilant monitoring, and can be instrumental in guiding both therapeutic applications and safety assessments of this particular medication.
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Affiliation(s)
- Jie Zhao
- Department of Pharmacy, Tongling People's Hospital, Tongling, Anhui Province, China
| | - Mei Wang
- Department of Pharmacy, Tongling Sixth People's Hospital, Tongling, Anhui Province, China
| | - Qing Yu
- Department of Pharmacy, Tongling People's Hospital, Tongling, Anhui Province, China
| | - Yi Yang
- Department of Infection, The First Affiliated Hospital Of Anhui Medical University, Hefei, Anhui Province, China
| | - Bin Zhang
- Department of Cardiovascular, Tongling People's Hospital, Tongling, Anhui Province, China
| | - Sanhua Zhan
- Department of Pharmacy, Tongling People's Hospital, Tongling, Anhui Province, China
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2
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Álvarez-Hernández MP, Allanore Y, Andrade I, Buch MH, Coghlan G, Del Galdo F, Denton CP, Khanna D, Kiely DG, Pauling JD, Ramjug S, Hughes M. Attitudes and barriers to pulmonary arterial hypertension screening in systemic sclerosis patients: A survey of UK-based rheumatologists. JOURNAL OF SCLERODERMA AND RELATED DISORDERS 2024; 9:99-109. [PMID: 38910595 PMCID: PMC11188845 DOI: 10.1177/23971983241235708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 01/12/2024] [Indexed: 06/25/2024]
Abstract
Objectives The objectives were to explore rheumatologists' current clinical screening practices of pulmonary arterial hypertension in patients with systemic sclerosis in the United Kingdom and to identify barriers to screening and consider potential solutions. Methods A survey of 31 questions was developed and included six sections: clinician demographics, the importance of screening, screening practices, barriers to screening, treatment and patient education. The survey was disseminated among rheumatologists working in the United Kingdom. Results Forty-four rheumatologists working in the United Kingdom participated in the study, and the majority completed all the questions. Around one-third (37.0%) worked in specialised systemic sclerosis units (university or general hospitals (54.5% and 45.4%, respectively)). The majority recognised that systemic sclerosis-pulmonary arterial hypertension is a major cause of morbidity and mortality. Over half (60.0%) reported using the DETECT algorithm to screen for systemic sclerosis-pulmonary arterial hypertension, although other algorithms were also sometimes used. All of the respondents utilised transthoracic echocardiogram, and almost all (95.0%) performed pulmonary function tests for screening purposes. Various challenges and barriers were identified relating to systemic sclerosis-pulmonary arterial hypertension screening, with the difficulty in interpreting results from other hospitals and extended wait times for diagnostic tests being the most reported (76.0% and 74.0%, respectively). Most respondents agreed that access to key investigations (87.0%), ongoing clinician education (82.0%), multidisciplinary meetings (79.5%) and a better understanding of proposed screening algorithms (79.5%) could be potential solutions. Conclusion Screening patients with systemic sclerosis for pulmonary arterial hypertension is crucial to improve survival, but variable practices exist among UK rheumatologists. Solutions include educating healthcare professionals on guidelines, sharing information between centres and integrating care services.
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Affiliation(s)
| | - Yannick Allanore
- Department of Rheumatology, Cochin Hospital, APHP, Université Paris Cité, Paris, France
| | - Ivo Andrade
- Department of Echocardiography, Manchester University NHS Foundation Trust, Manchester, UK
| | - Maya H Buch
- Division of Musculoskeletal and Dermatological Sciences and Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester, UK
| | - Gerry Coghlan
- National Pulmonary Hypertension Service, Royal Free Hospital, London, UK
| | - Francesco Del Galdo
- Leeds Institute of Rheumatic and Musculoskeletal Medicine and Biomedical Research Centre, University of Leeds, Leeds, UK
| | - Christopher P Denton
- National Pulmonary Hypertension Service, Royal Free Hospital, London, UK
- Centre for Rheumatology and Connective Tissue Diseases, Royal Free Hospital, London, UK
| | - Dinesh Khanna
- Scleroderma Program, University of Michigan, Ann Arbor, MI, USA
| | - David G Kiely
- National Pulmonary Hypertension Service, Royal Hallamshire Hospital, Sheffield, UK
- NIHR Sheffield Biomedical Research Centre, Sheffield, UK
| | - John D Pauling
- Department of Rheumatology, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Sheila Ramjug
- Department of Respiratory Medicine, Salford Care Organisation, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Michael Hughes
- Division of Musculoskeletal and Dermatological Sciences and Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- Department of Rheumatology, Salford Care Organisation and Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK
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D'Alto M, Badagliacca R, Airò E, Ameri P, Argiento P, Garascia A, Lombardi CM, Mulè M, Raineri C, Scelsi L, Vizza CD, Ghio S. Gaps in evidence in the management of patients with intermediate-risk pulmonary arterial hypertension: Considerations following the ESC/ERS 2022 guidelines. Vascul Pharmacol 2024; 155:107374. [PMID: 38642596 DOI: 10.1016/j.vph.2024.107374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 03/28/2024] [Accepted: 04/03/2024] [Indexed: 04/22/2024]
Abstract
A comprehensive evaluation of risk, using multiple indices, is necessary to provide reliable prognostic information and guide therapy in pulmonary arterial hypertension (PAH). The current ESC/ERS guidelines suggest using a three-strata model for incident (newly diagnosed) patients and a four-strata model for prevalent patients with PAH. The four-strata model serves as a fundamental risk-stratification tool and relies on a minimal dataset of indicators that must be considered during follow-up. Nevertheless, there are still areas of vagueness and ambiguity when classifying and managing patients in the intermediate-risk category. For these patients, considerations should include right heart imaging, hemodynamics, as well as individual factors such as age, sex, genetic profile, disease type, comorbidities, and kidney function. The aim of this report is to present case studies, with a specific focus on patients ultimately classified as intermediate risk. We aim to emphasize the challenges and complexities encountered in the realms of diagnosis, classification, and treatment for these particular patients.
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Affiliation(s)
- Michele D'Alto
- Department of Cardiology, Monaldi Hospital, Naples, Italy
| | - Roberto Badagliacca
- Department of Scienze Cliniche Internistiche, Anestesiologiche e Cardiologiche, Università "La Sapienza", Roma, Italy
| | - Edoardo Airò
- UO Pneumologia - Fondazione Toscana "G.Monasterio" - CNR/Regione Toscana, Pisa, Italy
| | - Pietro Ameri
- Department of Internal Medicine, University of Genova, Genova, Italy; Cardiac, Thoracic and Vascular Department, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Paola Argiento
- U.O.C. Cardiologia pediatrica e UTIC, A.O.R.N. dei colli - Ospedale Monaldi, Napoli, Italy
| | - Andrea Garascia
- Cardiologia 2 Insufficienza Cardiaca e Trapianti, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Carlo Mario Lombardi
- Institute of Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Massimiliano Mulè
- Clinical Cardiology and Heart Failure Unit, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Palermo, Italy
| | - Claudia Raineri
- Department of Cardiology, Città della salute- Molinette Hospital, Turin, Italy
| | - Laura Scelsi
- Fondazione I.R.C.C.S. Policlinico San Matteo Pavia, Pavia, Italy
| | - Carmine Dario Vizza
- Department of Scienze Cliniche Internistiche, Anestesiologiche e Cardiologiche, Università "La Sapienza", Roma, Italy
| | - Stefano Ghio
- UOC Cardiologia 1, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy.
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4
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Burger CD, Tsang Y, Chivers M, Vekaria RV, Doad G, Atkins N, Panjabi S. Oral Prostacyclin Pathway Agents Used in PAH: A Targeted Literature Review. CLINICOECONOMICS AND OUTCOMES RESEARCH 2024; 16:447-459. [PMID: 38831921 PMCID: PMC11146608 DOI: 10.2147/ceor.s460912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 05/14/2024] [Indexed: 06/05/2024] Open
Abstract
Purpose Pulmonary arterial hypertension (PAH) is a rare and progressive pulmonary vascular disease that can result in right heart failure and death. Oral prostacyclins play an important role in the management of intermediate-low risk PAH. This targeted literature review (TLR) aimed to identify and compare evidence supporting use of oral prostacyclin pathway agents (PPAs: selexipag and oral treprostinil) in intermediate-low risk PAH. Methods A targeted literature review was conducted. Literature databases (MEDLINE, Embase, and Cochrane reviews) were searched for studies describing clinical practice and treatment outcomes for oral treprostinil and selexipag globally, published in English (2012 to 2022). Electronic searches were supplemented by manual-searches of targeted conferences (2020 to 2022), and reference lists of identified publications were reviewed. One reviewer assessed studies for eligibility. Results In total, 95 publications met inclusion criteria: 47 full-text articles (selexipag n = 22; oral treprostinil n = 16; selexipag and oral treprostinil n = 9) and 48 conference materials. Selexipag and oral treprostinil target the prostacyclin pathway differently; their label-supporting trials had different primary endpoints (disease progression and hospitalization vs exercise capacity and disease progression), differing baseline therapy (0, 1 or 2 vs 0 or 1 baseline treatments), titration duration and dosing (personalized dose capped at 1600 ug twice daily (BID) vs increasing doses over time with no maximum dose), respectively. While both oral PPAs have demonstrated reduced risk of disease progression, only selexipag showed reduction in hospitalization rates. Oral PPAs have been shown to reduce healthcare costs in real-world clinical practice. This difference is reflected in labeled indications. Conclusion Given differences in trial- and real-world outcomes, number of prior therapies, and dosing, personalizing the choice of oral PPA is critical to maximizing the benefit for individual patients.
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Affiliation(s)
- Charles D Burger
- Division of Pulmonary Medicine, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Yuen Tsang
- Janssen Scientific Affiars, Titusville, NJ, USA
| | | | | | - Gurinderpal Doad
- Janssen Scientific Affiars, Titusville, NJ, USA
- Actelion Pharmaceuticals US, Inc, A Johnson and Johnson Co., Titusville, NJ, USA
| | | | - Sumeet Panjabi
- Janssen Scientific Affiars, Titusville, NJ, USA
- Actelion Pharmaceuticals US, Inc, A Johnson and Johnson Co., Titusville, NJ, USA
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5
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Bravo-Marqués R, Becerra-Muñoz V, Espíldora-Hernández F, Recio-Mayoral A. Effectiveness of a Prostacyclin IP Receptor Agonist in Patients With Pulmonary Arterial Hypertension in the Real-world Andalusian Setting: The RAMPHA Study. Clin Ther 2024:S0149-2918(24)00102-4. [PMID: 38762398 DOI: 10.1016/j.clinthera.2024.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 02/13/2024] [Accepted: 04/21/2024] [Indexed: 05/20/2024]
Abstract
PURPOSE The pillar for therapeutic decisions in the evolution of pulmonary arterial hypertension (PAH) is the patients' prognostic stratification. METHODS A retrospective cohort study was conducted in a Spanish real-world setting to assess the clinical improvement of PAH patients treated with selexipag measured as changes in the risk profile. Secondary objectives were to describe their baseline characteristics, initial risk status, and variables used to assess patient survival and adverse events. FINDINGS Total 42 patients (mean age 52.36 [SD: 15.09] years) were included. All had received initial endothelin receptor antagonist treatment and 95.2% dual therapy with phosphodiesterase-5 inhibitor or riociguat. At 6 to 12 months from baseline, patients risk stratification tripled the percentage of patients with low risk, and a trend towards improved risk stratification (P = 0.122). World Health Organization functional class changed, with more patients in milder classes (P = 0.003), and symptom progression slowed down (P < 0.0001). At 3-years, survival was 85.7% and the estimated median survival time was 2.73 years (SD: 1.351; 95% CI: 2.51-2.95). IMPLICATIONS Selexipag did not achieve a significant improvement in risk profile, although it did show an excellent survival rate, effectively improved functional class, and delayed symptom progression in real life. Selexipag was well tolerated and showed a favorable safety profile, supporting a clinical benefit for PAH patients.
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Affiliation(s)
| | - Víctor Becerra-Muñoz
- Cardiology Department. Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Málaga, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
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6
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Caputo A, Papa S, Manzi G, Laviola D, Recchioni T, Severino P, Lavalle C, Maestrini V, Mancone M, Badagliacca R, Vizza CD. Medical Management of Right Ventricular Dysfunction in Pulmonary Arterial Hypertension. Curr Heart Fail Rep 2023; 20:263-270. [PMID: 37486563 PMCID: PMC10421820 DOI: 10.1007/s11897-023-00612-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/12/2023] [Indexed: 07/25/2023]
Abstract
PURPOSE OF REVIEW The purpose of this review is to overview the most relevant and recent knowledge regarding medical management in pulmonary arterial hypertension (PAH). RECENT FINDINGS Evidence has shown that PAH patients' quality of life and prognosis depend on the capability of the RV to adapt to increased afterload and to fully recover in response to substantially reduced pulmonary vascular resistance obtained with medical therapy. Data from recent clinical studies show that more aggressive treatment strategies, especially in higher risk categories, determine larger afterload reductions, consequentially increasing the probability of achieving right heart reverse remodeling, therefore improving the patients' survival and quality of life. Remarkable progress has been observed over the past decades in the medical treatment of PAH, related to the development of drugs that target multiple biological pathways, strategies for earlier and more aggressive treatment interventions. New hopes for treatment of patients who are unable to achieve low-risk status have been derived from the phase 2 trial PULSAR and the phase 3 trial STELLAR, which show improvement in the hemodynamic status of patients treated with sotatercept on top of background therapy. Promising results are expected from several ongoing clinical trials targeting new pathways involved in the pathophysiology of PAH.
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Affiliation(s)
- Annalisa Caputo
- Department of Cardiovascular and Respiratory Science, Sapienza University of Rome, viale del Policlinico 155, 00161, Rome, Italy
| | - Silvia Papa
- Department of Cardiovascular and Respiratory Science, Sapienza University of Rome, viale del Policlinico 155, 00161, Rome, Italy.
| | - Giovanna Manzi
- Department of Cardiovascular and Respiratory Science, Sapienza University of Rome, viale del Policlinico 155, 00161, Rome, Italy
| | - Domenico Laviola
- Department of Cardiovascular and Respiratory Science, Sapienza University of Rome, viale del Policlinico 155, 00161, Rome, Italy
| | - Tommaso Recchioni
- Department of Cardiovascular and Respiratory Science, Sapienza University of Rome, viale del Policlinico 155, 00161, Rome, Italy
| | - Paolo Severino
- Department of Cardiovascular and Respiratory Science, Sapienza University of Rome, viale del Policlinico 155, 00161, Rome, Italy
| | - Carlo Lavalle
- Department of Cardiovascular and Respiratory Science, Sapienza University of Rome, viale del Policlinico 155, 00161, Rome, Italy
| | - Viviana Maestrini
- Department of Cardiovascular and Respiratory Science, Sapienza University of Rome, viale del Policlinico 155, 00161, Rome, Italy
| | - Massimo Mancone
- Department of Cardiovascular and Respiratory Science, Sapienza University of Rome, viale del Policlinico 155, 00161, Rome, Italy
| | - Roberto Badagliacca
- Department of Cardiovascular and Respiratory Science, Sapienza University of Rome, viale del Policlinico 155, 00161, Rome, Italy
| | - Carmine Dario Vizza
- Department of Cardiovascular and Respiratory Science, Sapienza University of Rome, viale del Policlinico 155, 00161, Rome, Italy
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7
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Del Pozo R, Blanco I, López-Meseguer M, Escribano-Subías P, Cruz Utrilla A. Effectiveness and persistence with selexipag in pulmonary arterial hypertension in the real-life setting. Eur J Intern Med 2023; 111:140-142. [PMID: 36720652 DOI: 10.1016/j.ejim.2023.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 01/23/2023] [Accepted: 01/25/2023] [Indexed: 01/31/2023]
Affiliation(s)
- R Del Pozo
- Pneumology Department, Hospital Universitario Juan Ramón Jiménez, Huelva, Spain
| | - I Blanco
- Pneumology Department, Pulmonary Hypertension Unit, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - M López-Meseguer
- Pneumology Depatrment, Hospital Universitario Vall d´Hebrón, Barcelona, Spain
| | - P Escribano-Subías
- Pulmonary Hypertension Unit, Cardiology Department, Hospital Universitario 12 de Octubre, Complutense University, Avenida de Andalucía S/N. 28041 Madrid, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.
| | - A Cruz Utrilla
- Pulmonary Hypertension Unit, Cardiology Department, Hospital Universitario 12 de Octubre, Complutense University, Avenida de Andalucía S/N. 28041 Madrid, Madrid, Spain
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8
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Nakashima N, Tahara N, Sugiyama Y, Bekki M, Maeda-Ogata S, Honda A, Goto C, Tanaka S, Fukumoto Y. Compression Stockings Improve Lower Legs Symptom in Patients with Pulmonary Artery Hypertension Treated by Pulmonary Vasodilators-A Pilot Study. J Clin Med 2023; 12:jcm12072484. [PMID: 37048566 PMCID: PMC10095423 DOI: 10.3390/jcm12072484] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 03/12/2023] [Accepted: 03/21/2023] [Indexed: 04/14/2023] Open
Abstract
Pulmonary vasodilators have improved pulmonary arterial hypertension (PAH) symptoms and prognosis; however, the drugs cause some side effects, including lower legs pain, which impair quality of life (QOL). The present study examined if compression stockings improved lower extremity symptoms and QOL caused by pulmonary vasodilators in PAH patients. We retrospectively enrolled consecutively ten patients with PAH treated by pulmonary vasodilators, who were regularly followed in Kurume University Hospital from January 2022 to June 2022. Oral questionnaire surveys, the Numeric Rating Scale for Pain (NRS) and the Pain Disability Assessment Scale (PDAS), were conducted regarding lower extremity symptoms before wearing elastic stockings and one month later, to evaluate how the lower extremity symptoms affected daily life. All ten patients were female, with a mean age of 50.2 ± 11.5 years, out of whom intravenous prostacyclin analogue (PGI2) was administered in five patients. In no intravenous PGI2 group, NRS score was significantly improved from 4.6 ± 2.3 to 2.8 ± 1.2 (p = 0.037), while from 9.4 ± 1.2 to 5.4 ± 1.6 (p = 0.002) in intravenous PGI2 group. PDAS score was also significantly improved [no intravenous PGI2 group; 18.0 (15.0-24.0) to 15.0 (10.0-19.0), intravenous PGI2 group; 25.0 (17.0-37.0) to 17.0 (5.0-27.0)]. Lower extremity symptoms in patients using pulmonary vasodilators were improved by wearing compression stockings.
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Affiliation(s)
- Naoko Nakashima
- Nursing Department, Kurume University Hospital, Kurume 830-0011, Japan
| | - Nobuhiro Tahara
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Kurume 830-0011, Japan
| | - Yoichi Sugiyama
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Kurume 830-0011, Japan
| | - Munehisa Bekki
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Kurume 830-0011, Japan
| | - Shoko Maeda-Ogata
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Kurume 830-0011, Japan
| | - Akihiro Honda
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Kurume 830-0011, Japan
| | - Chidu Goto
- Nursing Department, Kurume University Hospital, Kurume 830-0011, Japan
| | - Setsuko Tanaka
- Nursing Department, Kurume University Hospital, Kurume 830-0011, Japan
| | - Yoshihiro Fukumoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Kurume 830-0011, Japan
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9
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Alsina-Restoy X, Torres-Castro R, Torralba-García Y, Burgos F, Barberà JA, Agustí À, Blanco I. Does arterial oxygenation during exercise add prognostic value in pulmonary arterial hypertension? Respir Med 2023; 206:107070. [PMID: 36508987 DOI: 10.1016/j.rmed.2022.107070] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 11/30/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND The 6-min walking distance (6MWD) is often used to assess prognosis in pulmonary arterial hypertension (PAH) patients. Whether or not changes in arterial oxygen saturation (SpO2) during exercise add prognostic value to the 6MWD in these patients is unclear. The objective of this study was to investigate if SpO2 changes during exercise adds prognostic value to the 6MWD in PAH patients. METHODS Ambispective study that includes 137 patients with PAH: 38 idiopathic/heritable (i/h PAH), 42 with connective tissue disease (CTD-PAH), 34 with porto-pulmonary hypertension (PoPH), 21 with HIV-associated PAH and 2 with pulmonary venous occlusive disease (PVOD). Patients were characterized and, treated according to international recommendations, and were followed-up for 5 years. To integrate SpO2 changes during exercise, we calculated the desaturation distance ratio (DDR) either in its original form (from a maximal theoretical value of 100%) or the actual resting SpO2 value of the patient (new DDR) as well as the distance saturation product (DSP). RESULTS (1) during follow-up, 40 patients died (29.2%); (2) results confirmed the prognostic value of the 6MWD (AUC 0.913 [IQR 0.868-0.958]; p < 0.0001), original DDR (AUC 0.923 [0.881-0.966]; p < 0.001), New DDR (AUC 0.917 [0.872-0.961], p < 0.001), and DSP (AUC 0.914 [0.869-0.959], p < 0.001); and, (3) neither the original or new DDR or DSP added significant prognostic value to 6MWD in these patients. CONCLUSIONS Consideration of three different composite indices of arterial oxygenation changes during exercise does not add prognostic value to that of the 6MWD in patients with PAH.
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Affiliation(s)
- Xavier Alsina-Restoy
- Pulmonary Medicine Department, Respiratory Institute, Hospital Clinic Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Spain
| | - Rodrigo Torres-Castro
- Pulmonary Medicine Department, Respiratory Institute, Hospital Clinic Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Spain; Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Yolanda Torralba-García
- Pulmonary Medicine Department, Respiratory Institute, Hospital Clinic Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Spain; CIBER Enfermedades Respiratorias (CIBERES), Spain
| | - Felip Burgos
- Pulmonary Medicine Department, Respiratory Institute, Hospital Clinic Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Spain; University of Barcelona, Spain
| | - Joan Albert Barberà
- Pulmonary Medicine Department, Respiratory Institute, Hospital Clinic Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Spain; CIBER Enfermedades Respiratorias (CIBERES), Spain; University of Barcelona, Spain
| | - Àlvar Agustí
- Pulmonary Medicine Department, Respiratory Institute, Hospital Clinic Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Spain; CIBER Enfermedades Respiratorias (CIBERES), Spain; University of Barcelona, Spain
| | - Isabel Blanco
- Pulmonary Medicine Department, Respiratory Institute, Hospital Clinic Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Spain; CIBER Enfermedades Respiratorias (CIBERES), Spain; University of Barcelona, Spain.
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10
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Humbert M, McLaughlin V, Gibbs JSR, Gomberg-Maitland M, Hoeper MM, Preston IR, Souza R, Waxman AB, Ghofrani HA, Escribano Subias P, Feldman J, Meyer G, Montani D, Olsson KM, Manimaran S, de Oliveira Pena J, Badesch DB. Sotatercept for the treatment of pulmonary arterial hypertension: PULSAR open-label extension. Eur Respir J 2023; 61:13993003.01347-2022. [PMID: 36041750 PMCID: PMC9816418 DOI: 10.1183/13993003.01347-2022] [Citation(s) in RCA: 39] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 08/02/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND In participants with pulmonary arterial hypertension, 24 weeks of sotatercept resulted in a significantly greater reduction from baseline in pulmonary vascular resistance than placebo. This report characterises the longer-term safety and efficacy of sotatercept in the PULSAR open-label extension. We report cumulative safety, and efficacy at months 18-24, for all participants treated with sotatercept. METHODS PULSAR was a phase 2, randomised, double-blind, placebo-controlled study followed by an open-label extension, which evaluated sotatercept on top of background pulmonary arterial hypertension therapy in adults. Participants originally randomised to placebo were re-randomised 1:1 to sotatercept 0.3 or 0.7 mg·kg-1 (placebo-crossed group); those initially randomised to sotatercept continued the same sotatercept dose (continued-sotatercept group). Safety was evaluated in all participants who received ≥1 dose of sotatercept. The primary efficacy endpoint was change from baseline to months 18-24 in pulmonary vascular resistance. Secondary endpoints included 6-min walk distance and functional class. Two prespecified analyses, placebo-crossed and delayed-start, evaluated efficacy irrespective of dose. RESULTS Of 106 participants enrolled in the PULSAR study, 97 continued into the extension period. Serious treatment-emergent adverse events were reported in 32 (30.8%) participants; 10 (9.6%) reported treatment-emergent adverse events leading to study discontinuation. Three (2.9%) participants died, none considered related to study drug. The placebo-crossed group demonstrated significant improvement across primary and secondary endpoints and clinical efficacy was maintained in the continued-sotatercept group. CONCLUSION These results support the longer-term safety and durability of clinical benefit of sotatercept for pulmonary arterial hypertension.
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Affiliation(s)
- Marc Humbert
- Department of Respiratory and Intensive Care Medicine, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, INSERM Unité Mixte de Recherche 999, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Vallerie McLaughlin
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI, USA
| | - J Simon R Gibbs
- National Heart and Lung Institute, Imperial College London, and the National Pulmonary Hypertension Service, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Mardi Gomberg-Maitland
- Department of Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Marius M Hoeper
- Department of Respiratory Medicine, Hannover Medical School, and the German Center for Lung Research (DZL), Hannover, Germany
| | - Ioana R Preston
- Division of Pulmonary, Critical Care and Sleep Medicine, Tufts Medical Center, Boston, MA, USA
| | - Rogerio Souza
- Pulmonary Division-Heart Institute, University of São Paulo Medical School, São Paulo, Brazil
| | - Aaron B Waxman
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Pilar Escribano Subias
- Department of Cardiology, Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares, Hospital Universitario 12 de Octubre, Universidad Complutense, Madrid, Spain
| | | | - Gisela Meyer
- Complexo Hospitalar Santa Casa de Porto Alegre, Pulmonary Vascular Research Institute, Porto Alegre, Brazil
| | - David Montani
- Department of Respiratory and Intensive Care Medicine, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, INSERM Unité Mixte de Recherche 999, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Karen M Olsson
- Department of Respiratory Medicine, Hannover Medical School, and the German Center for Lung Research (DZL), Hannover, Germany
| | - Solaiappan Manimaran
- Acceleron Pharma Inc., a wholly owned subsidiary of Merck & Co., Inc., Rahway, NJ, USA
| | | | - David B Badesch
- Division of Pulmonary Sciences and Critical Care Medicine, and Cardiology, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
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Souza R, Delcroix M, Galié N, Jansa P, Mehta S, Pulido T, Rubin L, Sastry BKS, Simonneau G, Sitbon O, Torbicki A, Boyanova N, Chamitava L, Stein C, Channick RN. Long-Term Safety, Tolerability and Survival in Patients with Pulmonary Arterial Hypertension Treated with Macitentan: Results from the SERAPHIN Open-Label Extension. Adv Ther 2022; 39:4374-4390. [PMID: 35819570 PMCID: PMC9402744 DOI: 10.1007/s12325-022-02199-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 05/18/2022] [Indexed: 12/01/2022]
Abstract
Introduction In SERAPHIN, a long-term, event-driven, double-blind randomised controlled trial in pulmonary arterial hypertension (PAH), macitentan 10 mg significantly reduced the risk of morbidity/mortality compared with placebo. Its open-label extension study (SERAPHIN OL) further assessed long-term safety and tolerability of macitentan 10 mg in PAH patients. Methods Patients in SERAPHIN who completed the double-blind treatment period or experienced a morbidity event during the study could enter SERAPHIN OL. Patients received macitentan 10 mg once daily, and safety and survival were assessed until end of treatment (+ 28 days). Two overlapping sets were analysed for safety: (1) all patients in SERAPHIN OL (OL safety set); (2) patients randomised to macitentan 10 mg in SERAPHIN (long-term safety/survival set). Survival was evaluated as an exploratory endpoint in the latter set. Results Of 742 patients randomised in SERAPHIN, 550 (74.1%) entered SERAPHIN OL (OL safety set); 242 patients were randomised to macitentan 10 mg in SERAPHIN (long-term safety/survival set). Median (min, max) exposure to macitentan 10 mg was 40.1 (0.1, 130.5) months (2074.7 patient-years; OL safety set) and 54.7 (0.1, 141.3) months (1151.0 patient-years; long-term safety/survival set). Safety in both analysis sets was comparable to the known safety profile of macitentan. Kaplan-Meier survival estimates (95% CI) at 1, 5, 7 and 9 years were 95.0% (91.3, 97.1), 73.3% (66.6, 78.9), 62.6% (54.6, 69.6) and 52.7% (43.6, 61.0), respectively (long-term safety/survival set; median follow-up: 5.9 years). Conclusions This analysis provides the longest follow-up for safety and survival published to date for any PAH therapy. The safety profile of macitentan 10 mg over this extensive treatment period was in line with that observed in SERAPHIN. As the majority of patients were receiving other PAH therapy at macitentan initiation, our study provides additional insight into the long-term safety of macitentan, including as part of combination therapy. Trial Registration ClinicalTrials.gov Identifiers: NCT00660179 and NCT00667823. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-022-02199-x.
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Affiliation(s)
- Rogério Souza
- Pulmonary Division, Heart Institute (INCOR), University of Sao Paulo, Av.Dr. Eneás de Carvalho Aguiar, 255, sala 7079, Sao Paulo, SP, CEP 06.403-010, Brazil.
| | - Marion Delcroix
- Clinical Department of Respiratory Diseases, Centre of Pulmonary Vascular Diseases, University Hospitals of Leuven, Leuven, Belgium.,BREATHE, Department of Chronic Diseases and Metabolism (CHROMETA), KU Leuven, Leuven, Belgium
| | | | - Pavel Jansa
- 2nd Department of Internal Medicine, Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Sanjay Mehta
- Southwest Ontario PH Clinic, Respirology Division, London Health Sciences Centre, Western University, London, ON, Canada
| | - Tomás Pulido
- Department of Clinical Research, Ignacio Chávez National Heart Institute, Mexico City, Mexico
| | - Lewis Rubin
- University of California, San Diego Medical School, San Diego, CA, USA
| | | | - Gérald Simonneau
- Hôpital Bicêtre, Université Paris-Sud, Le Kremlin Bicêtre, France
| | - Olivier Sitbon
- Hôpital Bicêtre, Université Paris-Sud, Le Kremlin Bicêtre, France
| | - Adam Torbicki
- Department of Pulmonary Circulation, Thromboembolic Disease and Cardiology, Centre for Postgraduate Medical Education, ECZ-Otwock, Otwock, Poland
| | - Neli Boyanova
- Actelion Pharmaceuticals Ltd, Allschwil, Switzerland
| | | | - Claudia Stein
- Actelion Pharmaceuticals Ltd, Allschwil, Switzerland
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Christou H, Khalil RA. Mechanisms of pulmonary vascular dysfunction in pulmonary hypertension and implications for novel therapies. Am J Physiol Heart Circ Physiol 2022; 322:H702-H724. [PMID: 35213243 PMCID: PMC8977136 DOI: 10.1152/ajpheart.00021.2022] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/22/2022] [Accepted: 02/22/2022] [Indexed: 12/21/2022]
Abstract
Pulmonary hypertension (PH) is a serious disease characterized by various degrees of pulmonary vasoconstriction and progressive fibroproliferative remodeling and inflammation of the pulmonary arterioles that lead to increased pulmonary vascular resistance, right ventricular hypertrophy, and failure. Pulmonary vascular tone is regulated by a balance between vasoconstrictor and vasodilator mediators, and a shift in this balance to vasoconstriction is an important component of PH pathology, Therefore, the mainstay of current pharmacological therapies centers on pulmonary vasodilation methodologies that either enhance vasodilator mechanisms such as the NO-cGMP and prostacyclin-cAMP pathways and/or inhibit vasoconstrictor mechanisms such as the endothelin-1, cytosolic Ca2+, and Rho-kinase pathways. However, in addition to the increased vascular tone, many patients have a "fixed" component in their disease that involves altered biology of various cells in the pulmonary vascular wall, excessive pulmonary artery remodeling, and perivascular fibrosis and inflammation. Pulmonary arterial smooth muscle cell (PASMC) phenotypic switch from a contractile to a synthetic and proliferative phenotype is an important factor in pulmonary artery remodeling. Although current vasodilator therapies also have some antiproliferative effects on PASMCs, they are not universally successful in halting PH progression and increasing survival. Mild acidification and other novel approaches that aim to reverse the resident pulmonary vascular pathology and structural remodeling and restore a contractile PASMC phenotype could ameliorate vascular remodeling and enhance the responsiveness of PH to vasodilator therapies.
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Affiliation(s)
- Helen Christou
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Raouf A Khalil
- Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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