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Frank BS, Gentzler ER, Avitabile CM, Miller-Reed K, Pan Z, Rosenzweig EB, Ivy DD, Krishnan US. Safety and Effectiveness of Selexipag in Pediatric Pulmonary Hypertension: A Retrospective Multicenter Cohort Study. J Pediatr 2024; 275:114221. [PMID: 39097266 DOI: 10.1016/j.jpeds.2024.114221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 06/20/2024] [Accepted: 07/29/2024] [Indexed: 08/05/2024]
Abstract
OBJECTIVE To describe the safety and effectiveness of treating pediatric patients who have pulmonary arterial hypertension (PAH) with selexipag in a real-world, multicenter cohort, given that data supporting its use in pediatric PAH are sparse. STUDY DESIGN We report a multicenter, retrospective, cohort study of children with PAH treated with selexipag. Demographic and clinical variables were extracted from the medical records. Clinical parameters were analyzed at 3 timepoints: before selexipag, 3-12 months after selexipag, and >12 months follow-up. RESULTS Eighty-seven patients were included, 32 received selexipag as add-on to background therapy, and 55 transitioned from another prostanoid. The median starting and final doses were 4.7 and 28.5 μg/kg/dose twice daily, respectively. Add-on patients demonstrated improved indexed pulmonary to systemic vascular resistance ratio after selexipag initiation (PVRi/SVRi, 0.62v0.53; P = .034) with a lower average mean pulmonary artery pressure (46 vs 39 mm Hg; P = NS), and oxygen consumption (maximal oxygen consumption during cardiopulmonary exercise testing [VO2 max] 27.8 mL/kg/min vs 30.9 mL/kg/min; P = NS). Transition patients demonstrated stable mean pulmonary artery pressure (47 mm Hg vs 45 mm Hg; P = NS) and a lower mean indexed pulmonary vascular resistance (10.9 Wood units∗m2 vs 8.2 Wood units∗m2; P = NS) but late functional worsening in some with VO2 max decreased at follow-up (26.0 mL/kg/min vs 19.5 mL/kg/min). Side effects were noted in 40% of the cohort, but prompted discontinuation in only 2%. CONCLUSIONS In a large, multicenter cohort, the oral prostacyclin agonist selexipag demonstrates favorable tolerability and effectiveness. Add-on patients demonstrated early hemodynamic improvement. Transition patients demonstrated early stability with risk of late functional worsening, highlighting the importance of ongoing monitoring.
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Affiliation(s)
- Benjamin S Frank
- Section of Cardiology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO.
| | - Eliza R Gentzler
- Section of Cardiology, Department of Pediatrics, Columbia University Irving Medical Center, Morgan Stanley Childrens Hospital of New York Presbyterian Hospital, New York, NY
| | - Catherine M Avitabile
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Kathleen Miller-Reed
- Section of Cardiology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Zhaoxing Pan
- Department of Biostatistics, Children's Hospital Colorado, Aurora, CO
| | - Erika B Rosenzweig
- Section of Cardiology, Department of Pediatrics, Columbia University Irving Medical Center, Morgan Stanley Childrens Hospital of New York Presbyterian Hospital, New York, NY
| | - D Dunbar Ivy
- Section of Cardiology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Usha S Krishnan
- Section of Cardiology, Department of Pediatrics, Columbia University Irving Medical Center, Morgan Stanley Childrens Hospital of New York Presbyterian Hospital, New York, NY
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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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Tamura Y, Kumamaru H, Tsujino I, Suda R, Abe K, Inami T, Horimoto K, Adachi S, Yasuda S, Sera F, Taniguchi Y, Kuwana M, Tatsumi K. Switching from Beraprost to Selexipag in the Treatment of Pulmonary Arterial Hypertension: Insights from a Phase IV Study of the Japanese Registry (The EXCEL Study: EXChange from bEraprost to seLexipag Study). Pharmaceuticals (Basel) 2024; 17:555. [PMID: 38794126 PMCID: PMC11124036 DOI: 10.3390/ph17050555] [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: 03/18/2024] [Revised: 04/20/2024] [Accepted: 04/22/2024] [Indexed: 05/26/2024] Open
Abstract
Pulmonary arterial hypertension (PAH) remains a significant challenge in cardiology, necessitating advancements in treatment strategies. This study explores the safety and efficacy of transitioning patients from beraprost to selexipag, a novel selective prostacyclin receptor agonist, within a Japanese cohort. Employing a multicenter, open-label, prospective design, 25 PAH patients inadequately managed on beraprost were switched to selexipag. Key inclusion criteria included ongoing beraprost therapy for ≥3 months, a diagnosis of PAH confirmed by mean pulmonary artery pressure (mPAP) ≥ 25 mmHg, and current treatment with endothelin receptor antagonists and/or phosphodiesterase type 5 inhibitors. Outcomes assessed were changes in hemodynamic parameters (mPAP, cardiac index, pulmonary vascular resistance) and the 6 min walk distance (6-MWD) over 3-6 months. The study found no statistically significant changes in these parameters post-switch. However, a subset of patients, defined as responders, demonstrated improvements in all measured hemodynamic parameters, suggesting a potential benefit in carefully selected patients. The transition was generally well-tolerated with no serious adverse events reported. This investigation underscores the importance of personalized treatment strategies in PAH, highlighting that certain patients may benefit from switching to selexipag, particularly those previously on higher doses of beraprost. Further research is needed to elucidate the predictors of positive response to selexipag and optimize treatment regimens for this complex condition.
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Affiliation(s)
- Yuichi Tamura
- Pulmonary Hypertension Center, International University of Health and Welfare Mita Hospital, Tokyo 108-8329, Japan
| | - Hiraku Kumamaru
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8654, Japan;
| | - Ichizo Tsujino
- Division of Respiratory and Cardiovascular Innovative Research, Faculty of Medicine, Hokkaido University, Sapporo 060-8638, Japan;
| | - Rika Suda
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan; (R.S.); (K.T.)
| | - Kohtaro Abe
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan;
| | - Takumi Inami
- Department of Cardiovascular Medicine, Kyorin University School of Medicine, Tokyo 160-8582, Japan;
| | - Koshin Horimoto
- Department of Cardiovascular Medicine, Matsuyama Red Cross Hospital, Matsuyama 790-0826, Japan
| | - Shiro Adachi
- Department of Cardiology, Nagoya University Hospital, Nagoya 466-8560, Japan;
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai 980-0872, Japan
| | - Fusako Sera
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita 565-0871, Japan
| | - Yu Taniguchi
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan;
| | - Masataka Kuwana
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Tokyo 113-8602, Japan;
- Scleroderma/Myositis Center of Excellence (SMCE), Nippon Medical School Hospital, Tokyo 113-8603, Japan
| | - Koichiro Tatsumi
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan; (R.S.); (K.T.)
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Li M, Liu L, Liu C, Chen Z, Li W, Li X, Ma X, Zhang Y. Selexipag for the Treatment of Pediatric Pulmonary Hypertension: A Systematic Review. Clin Ther 2024; 46:59-68. [PMID: 37945502 DOI: 10.1016/j.clinthera.2023.09.026] [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: 04/27/2023] [Revised: 09/27/2023] [Accepted: 09/28/2023] [Indexed: 11/12/2023]
Abstract
PURPOSE To systematically evaluate the safety, dosing regimen, and efficacy of selexipag for pediatric patients with pulmonary hypertension (PH). METHODS A literature search of the electronic databases of PubMed, Embase, Web of Science, Cochrane Library, and Google Scholar was performed from inception through February 28, 2023. Two reviewers independently searched and evaluated the quality of the studies and pooled data when appropriate. Full-text articles of studies of children diagnosed with PH and treated with selexipag were eligible. Pediatric patients with PH were classified into 2 groups: the add-on therapy group, in which selexipag was used as a third therapy in addition to the baseline treatment, and the transition therapy group, in which patients were switched from parenteral prostacyclin analogs to selexipag. FINDINGS Fourteen studies involving 58 pediatric patients with PH were included. All studies were either case reports or case series. Overall, 30 and 28 patients were in the add-on and transition therapy groups, respectively. In both groups, selexipag was initially administered as 50-200 µg twice daily and titrated to a tolerated dosage of 200-1,600 µg twice daily. Prostacyclin analogs were simultaneously weaned for patients in the transition group. In the add-on therapy group, 16 patients (80.0%) were at low risk of the World Health Organization functional class (WHO FC I/II), 12 (76.9%) were at low risk of the 6-minute walk distance (6MWD; >350 m), and 21 (95.5%) were at low risk of the pulmonary vascular resistance index (PVRi; <20 WU/m2). Furthermore, N-terminal pro-brain natriuretic peptide and mean pulmonary arterial pressure were significantly improved. More than 70% of patients experienced common tolerable side effects, such as headache, nausea, and diarrhea. In the transition therapy group, 5 patients (55.6%) were at low risk according to WHO FC I/II, 6 (66.7%) were at low risk according to 6MWD, and 14 (87.5) were at low risk according to PVRi; however, selexipag had no significant effect on their hemodynamic parameters. Additionally, more than 80% of patients experienced no side effects. IMPLICATIONS Selexipag as add-on therapy or for transition from prostacyclin analogs may have a favorable safety profile and potential efficacy for pediatric patients with PH. Further high-quality evidence of the efficacy and safety of selexipag for the treatment of pediatric PH is warranted.
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Affiliation(s)
- Meng Li
- Department of Pharmacy, Shenzhen Children's Hospital, Shenzhen, China
| | - Lin Liu
- Department of Cardiology, Shenzhen Children's Hospital, Shenzhen, China
| | - Cong Liu
- Department of Cardiology, Shenzhen Children's Hospital, Shenzhen, China
| | - Zebin Chen
- Department of Cardiology, Shenzhen Children's Hospital, Shenzhen, China
| | - Weibin Li
- Department of Cardiology, Shenzhen Children's Hospital, Shenzhen, China
| | - Xuejuan Li
- Department of Cardiology, Shenzhen Children's Hospital, Shenzhen, China
| | - Xiaopeng Ma
- Department of General Surgery, Shenzhen Children's Hospital, Shenzhen, China
| | - Yumao Zhang
- Department of Pharmacy, the Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, China.
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Li L, Zhu X, Chen X, Gao J, Ding C, Zhang M, Ma S. Advances in targeted therapy for pulmonary arterial hypertension in children. Eur J Pediatr 2023; 182:2067-2076. [PMID: 36527480 DOI: 10.1007/s00431-022-04750-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 11/29/2022] [Accepted: 12/02/2022] [Indexed: 12/23/2022]
Abstract
Pulmonary arterial hypertension (PAH) is a rare and devastating disease of the pulmonary vasculature with a high morbidity and mortality rate in infants and children. Currently, treatment approaches are mostly based on adult guidelines and pediatrician clinical experience, focusing on specific pulmonary antihypertensive therapy and conventional supportive care. The advent of targeted drugs has led to significant advances in the treatment of PAH in children, including endothelin receptor antagonists, phosphodiesterase type 5 inhibitors, and prostacyclins, which have been studied and proven to improve hemodynamics and functional class in children PAH. A new targeted drug, riociguat, is assessing its safety and efficacy in clinical trials. However, more randomized controlled studies are needed to evaluate the combination of drugs, treatment strategies, and clinical endpoints of targeted therapy in children PAH. In this review, we summarize the research advances of PAH-targeted therapy in children over the last decade in order to provide a theoretical basis for future studies. CONCLUSION Pulmonary arterial hypertension (PAH) is a rare and devastating pulmonary vascular disease that is associated with a variety of diseases of any age in childhood onset. WHAT IS KNOWN • Therapeutic strategies for targeted drugs for PAH in children are based almost exclusively on data from adult studies and clinical experience of pediatric specialists. • Due to the complex etiology of PAH in children and the relative lack of clinical trial data, the selection of appropriate targeted drug therapy remains difficult. WHAT IS NEW • We redefine the definition of pulmonary arterial hypertension in children and summarize the progress of targeted therapy of pulmonary arterial hypertension in children in the past ten years. • The dosage and adverse reactions were summarized, and the mechanism of action was drawn according to the available targeted drugs. It can provide theoretical support for the development of guidelines and treatment strategies for the diagnosis and treatment of pulmonary arterial hypertension in children.
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Affiliation(s)
- Li Li
- Department of Scientific Research, Gansu Provincial Hospital, 204 West Donggang R.D., Lanzhou, 730000, China
| | - Xinyu Zhu
- Department of Scientific Research, Gansu Provincial Hospital, 204 West Donggang R.D., Lanzhou, 730000, China
| | - Xiaojie Chen
- Department of Scientific Research, Gansu Provincial Hospital, 204 West Donggang R.D., Lanzhou, 730000, China
| | - Jieyun Gao
- Department of Scientific Research, Gansu Provincial Hospital, 204 West Donggang R.D., Lanzhou, 730000, China
| | - Chunchun Ding
- Department of Pharmacy, Gansu Provincial Hospital, 204 West Donggang R.D., Lanzhou, 730000, China
| | - Min Zhang
- Department of Scientific Research, Gansu Provincial Hospital, 204 West Donggang R.D., Lanzhou, 730000, China.
| | - Shixun Ma
- First Clinical College of Medicine, Lanzhou University, 1st West Donggang R.D., Lanzhou, 730000, China.
- General Surgery, Gansu Provincial Hospital, 204 West Donggang R.D., Lanzhou, 730000, China.
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Colglazier E, Stevens L, Parker C, Nawaytou HM, Amin EK, Becerra J, Steurer M, Fineman JR. Hemodynamic assessment of transitioning from parenteral prostacyclin to selexipag in pediatric pulmonary hypertension. Pulm Circ 2022; 12:e12159. [PMID: 36514390 PMCID: PMC9732384 DOI: 10.1002/pul2.12159] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 11/02/2022] [Accepted: 11/07/2022] [Indexed: 11/13/2022] Open
Abstract
Despite the increase in therapeutic options, parenteral prostacyclins remain the cornerstone in the medical management of pulmonary arterial hypertension (PAH). While the use of parenteral prostacyclins in pediatric patients is well documented, less is known about alternative drug delivery methods such as enteral administration. Given that parenteral routes of prostacyclin administration (IV or SC) are invariably accompanied by complicated logistics and lifestyle compromises, enteral prostacyclin administration represents an attractive treatment option. Selexipag (Uptravi®) was approved for adults PAH in 2015. There is limited data on the hemodynamic efficacy of transitioning from parenteral prostacyclins to selexipag, particularly in the pediatric population. We report 11 pediatric PAH patients who underwent this transition, in which 10 had complete cardiac catheterization data before and following the transition to selexipag. All patients/families reported an improvement in quality of life, and the transitions occurred without adverse effects. However, 3 of the 11 (27%) did not tolerate the transition; two for worsening hemodynamics, and one for acute right ventricular failure in the setting of an intercurrent illness. In addition, the transition to selexipag was associated with a modest increase in pulmonary vascular resistance index (6/10) and decrease in cardiac index (6/10) in some patients. Selexipag use in pediatric PAH represents a significant addition to our therapeutic arsenal, and its use provides a meaningful improvement in quality of life compared with other prostacyclin formulations. However, when goals of care include aggressive disease management, a decision between improved quality of life and possible adverse outcomes must be considered, and its substitution should include cautious, close, long-term follow-up.
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Affiliation(s)
- Elizabeth Colglazier
- Department of PediatricsUCSF Benioff Children's HospitalSan FranciscoCaliforniaUSA
| | - Leah Stevens
- Department of PediatricsUCSF Benioff Children's HospitalSan FranciscoCaliforniaUSA
| | - Claire Parker
- Department of PediatricsUCSF Benioff Children's HospitalSan FranciscoCaliforniaUSA
| | - Hythem M. Nawaytou
- Department of PediatricsUCSF Benioff Children's HospitalSan FranciscoCaliforniaUSA
| | - Elena K. Amin
- Department of PediatricsUCSF Benioff Children's HospitalSan FranciscoCaliforniaUSA
| | - Jasmine Becerra
- Department of PediatricsUCSF Benioff Children's HospitalSan FranciscoCaliforniaUSA
| | - Martina Steurer
- Department of PediatricsUCSF Benioff Children's HospitalSan FranciscoCaliforniaUSA
| | - Jeffrey R. Fineman
- Department of PediatricsUCSF Benioff Children's HospitalSan FranciscoCaliforniaUSA
- UCSF Cardiovascular Research InstituteSan FranciscoCaliforniaUSA
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