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Channick R, Chin KM, McLaughlin VV, Lammi MR, Zamanian RT, Turricchia S, Ong R, Mitchell L, Kim NH. Macitentan in Pulmonary Arterial Hypertension Associated with Connective Tissue Disease (CTD-PAH): Real-World Evidence from the Combined OPUS/OrPHeUS Dataset. Cardiol Ther 2024:10.1007/s40119-024-00361-w. [PMID: 38451426 DOI: 10.1007/s40119-024-00361-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 02/14/2024] [Indexed: 03/08/2024] Open
Abstract
INTRODUCTION Data on real-world clinical practice and outcomes of patients with pulmonary arterial hypertension associated with connective tissue disease (CTD-PAH) are scarce. The OPUS/OrPHeUS studies enrolled patients newly initiating macitentan, including those with CTD-PAH. This analysis describes patient characteristics, treatment patterns, outcomes, and safety profiles of patients with CTD-PAH newly initiating macitentan in the US using the OPUS/OrPHeUS combined dataset. METHODS OPUS was a prospective, US, multicenter, long-term, observational drug registry (April 2014-June 2020). OrPHeUS was a retrospective, US, multicenter medical chart review (October 2013-March 2017). The characteristics, treatment patterns, safety, and outcomes during macitentan treatment of patients with CTD-PAH and its subgroups systemic sclerosis (SSc-PAH), systemic lupus erythematosus (SLE-PAH), and mixed CTD (MCTD-PAH) were descriptively compared to patients with idiopathic/heritable PAH (I/HPAH). RESULTS The combined OPUS/OrPHeUS population included 2498 patients with I/HPAH and 1192 patients with CTD-PAH (708 SSc-PAH; 159 SLE-PAH; 124 MCTD-PAH, and 201 other CTD-PAH etiologies). At macitentan initiation for patients with I/HPAH and CTD-PAH, respectively: 61.2 and 69.3% were in World Health Organization functional class (WHO FC) III/IV; median 6-min walk distance was 289 and 279 m; and 58.1 and 65.2% received macitentan as combination therapy. During follow-up, for patients with I/HPAH and CTD-PAH, respectively: median duration of macitentan exposure observed was 14.0 and 15.8 months; 79.0 and 83.0% experienced an adverse event; Kaplan-Meier estimates (95% confidence limits [CL]) of patients free from all-cause hospitalization at 1 year were 60.3% (58.1, 62.4) and 59.3% (56.1, 62.3); and Kaplan-Meier estimates (95% CL) of survival at 1 year were 90.5% (89.1, 91.7) and 90.6% (88.6, 92.3). CONCLUSIONS Macitentan was used in clinical practice in patients with CTD-PAH and its subgroups, including as combination therapy. The safety and tolerability profile of macitentan in patients with CTD-PAH was comparable to that of patients with I/HPAH. TRIAL REGISTRATION OPsumit® Users Registry (OPUS): NCT02126943; Opsumit® Historical Users cohort (OrPHeUS): NCT03197688; www. CLINICALTRIALS gov Graphical abstract available for this article.
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Affiliation(s)
- Richard Channick
- David Geffen School of Medicine, University of California, Los Angeles, UCLA, 37-131 CHS, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA.
| | | | | | | | | | - Stefano Turricchia
- Actelion Pharmaceuticals Ltd, a Johnson & Johnson Company, Global Medical Affairs, Allschwil, Switzerland
| | - Rose Ong
- Actelion Pharmaceuticals Ltd, a Johnson & Johnson Company, Global Epidemiology, Allschwil, Switzerland
| | - Lada Mitchell
- Actelion Pharmaceuticals Ltd, a Johnson & Johnson Company, Statistics & Decision Sciences-Medical Affairs and Established Products, Allschwil, Switzerland
| | - Nick H Kim
- University of California, San Diego, La Jolla, CA, USA
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O'Meara K, Stone G, Buch E, Brownstein A, Saggar R, Channick R, Sherman AE, Bender A. Atrial Arrhythmias in Patients with Pulmonary Hypertension. Chest 2024:S0012-3692(24)00291-5. [PMID: 38453002 DOI: 10.1016/j.chest.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 03/01/2024] [Accepted: 03/04/2024] [Indexed: 03/09/2024] Open
Abstract
TOPIC IMPORTANCE Atrial arrhythmia (AA) are common in patients with pulmonary hypertension (PH) and contribute to morbidity and mortality. Given the growing PH population, it is important to understand the pathophysiology, clinical impact, and management of AA in PH. REVIEW FINDINGS AA occurs in PH with a five-year incidence of 10-25%. AA confers a higher morbidity and mortality, and restoration of normal sinus rhythm improves survival and functionality. AA is thought to develop due to structural alterations of the right atrium caused by changes to the right ventricle (RV) due to elevated pulmonary artery pressures. AA can subsequently worsen RV function. Current guidelines do not provide comprehensive recommendations for the management of AA in PH. There is a lack of robust evidence to favor a specific treatment approach. While the role of medical rate or rhythm control, and the use of cardioversion and ablation, can be inferred from other populations, there is a lack of evidence in the PH population. Much remains to be determined regarding the optimal management strategy. We present here our institutional approach and discuss areas for future research. SUMMARY This review highlights the epidemiology and pathophysiology of AA in patients with PH, describes the relationship between AA and RV dysfunction, and discusses current management practices. We outline our institutional approach and offer directions for future investigation.
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Affiliation(s)
- Kyle O'Meara
- Cedars Sinai Medical Center, Department of Pulmonary & Critical Care Medicine, Los Angeles, CA
| | - Gregory Stone
- UCLA Department of Internal Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Eric Buch
- UCLA Cardiac Arrhythmia Center, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Adam Brownstein
- Division of Pulmonary, Critical Care, Sleep Medicine, Clinical Immunology and Allergy, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Rajan Saggar
- Division of Pulmonary, Critical Care, Sleep Medicine, Clinical Immunology and Allergy, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Richard Channick
- Division of Pulmonary, Critical Care, Sleep Medicine, Clinical Immunology and Allergy, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Alexander E Sherman
- Division of Pulmonary, Critical Care, Sleep Medicine, Clinical Immunology and Allergy, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Aron Bender
- UCLA Cardiac Arrhythmia Center, David Geffen School of Medicine at UCLA, Los Angeles, CA
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Torbicki A, Channick R, Galiè N, Kiely DG, Moceri P, Peacock A, Swift AJ, Tawakol A, Vonk Noordegraaf A, Flores D, Martin N, Rosenkranz S. Effect of Macitentan in Pulmonary Arterial Hypertension and the Relationship Between Echocardiography and cMRI Variables: REPAIR Echocardiography Sub-study Results. Cardiol Ther 2024; 13:173-190. [PMID: 38281309 PMCID: PMC10899124 DOI: 10.1007/s40119-023-00345-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 12/04/2023] [Indexed: 01/30/2024] Open
Abstract
INTRODUCTION The aim of this sub-study was to evaluate the relationship between echocardiography (echo) and cardiac magnetic resonance imaging (cMRI) variables and to utilize echo to assess the effect of macitentan on right ventricle (RV) structure and function. METHODS REPAIR (NCT02310672) was a prospective, multicenter, single-arm, open-label, 52-week, phase 4 study in pulmonary arterial hypertension (PAH) patients, which investigated the effect of macitentan 10 mg as monotherapy, or in combination with a phosphodiesterase 5 inhibitor, on RV structure, function, and hemodynamics using cMRI and right heart catheterization. In this sub-study, patients were also assessed by echo at screening and at weeks 26 and/or 52. Post hoc correlation analyses between echo and cMRI variables were performed using Pearson's correlation coefficient, Spearman's correlation coefficient, and Bland-Altman analyses. RESULTS The Echo sub-study included 45 patients. Improvements in echo-assessed RV stroke volume (RVSV), left ventricular SV (LVSV), LV end-diastolic volume (LVEDV), RV fractional area change (RVFAC), tricuspid annular plane systolic excursion (TAPSE), and in 2D global longitudinal RV strain (2D GLRVS) were observed at weeks 26 and 52 compared to baseline. There was a strong correlation between echo (LVSV, 2D GLRVS, and LVEDV) and cMRI variables, with a moderate correlation for RVSV. Bland-Altman analyses showed a good agreement for LVSV measured by echo versus cMRI, whereas an overestimation in echo-assessed RVSV was observed compared to cMRI (bias of - 15 mL). Hemodynamic and functional variables, as well as safety, were comparable between the Echo sub-study and REPAIR. CONCLUSIONS A good relationship between relevant echo and cMRI parameters was shown. Improvements in RV structure and function with macitentan treatment was observed by echo, consistent with results observed by cMRI in the primary analysis of the REPAIR study. Echo is a valuable complementary method to cMRI, with the potential to non-invasively monitor treatment response at follow-up. TRIAL REGISTRATION NUMBER REPAIR NCT02310672.
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Affiliation(s)
- Adam Torbicki
- Department of Pulmonary Circulation, Thromboembolic Disease and Cardiology, Centre for Postgraduate Medical Education ECZ-Otwock, ERN-LUNG Member, F. Chopin Hospital European Health Centre, ul. Borowa 14/18, 05-400, Otwock, Poland.
| | | | - Nazzareno Galiè
- Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna and Dipartimento DIMES, Università di Bologna, Bologna, Italy
| | - David G Kiely
- Sheffield Pulmonary Vascular Disease Unit, NIHR Biomedical Research Centre Sheffield and University of Sheffield, Sheffield, UK
| | - Pamela Moceri
- Cardiology Department, UR2CA, Pasteur University Hospital, Côte-d'Azur University, Nice, France
| | | | - Andrew J Swift
- Department of Infection, Immunity & Cardiovascular Disease, National Institute for Health and Care Research Sheffield Biomedical Research Centre, University of Sheffield, Sheffield, UK
| | - Ahmed Tawakol
- Massachusetts General Hospital and Harvard Medical School, Boston, USA
| | | | - Dayana Flores
- Actelion Pharmaceuticals Ltd, a Janssen Pharmaceutical Company of Johnson & Johnson, Global Medical Affairs, Allschwil, Switzerland
| | - Nicolas Martin
- Actelion Pharmaceuticals Ltd, a Janssen Pharmaceutical Company of Johnson & Johnson, Statistical Decision Science, Allschwil, Switzerland
| | - Stephan Rosenkranz
- Department of Cardiology, Heart Center, University Hospital Cologne, and Cologne Cardiovascular Research Center (CCRC), University of Cologne, Cologne, Germany
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Kim NH, Chin KM, McLaughlin VV, DuBrock H, Restrepo-Jaramillo R, Safdar Z, MacDonald G, Martin N, Rosenberg D, Solonets M, Channick R. Safety of Macitentan for the Treatment of Portopulmonary Hypertension: Real-World Evidence from the Combined OPUS/OrPHeUS Studies. Pulm Ther 2024; 10:85-107. [PMID: 38184507 PMCID: PMC10881949 DOI: 10.1007/s41030-023-00251-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 12/14/2023] [Indexed: 01/08/2024] Open
Abstract
INTRODUCTION Portopulmonary hypertension (PoPH) carries a worse prognosis than other forms of pulmonary arterial hypertension (PAH). Data regarding use of PAH-specific therapies in patients with PoPH are sparse as they are usually excluded from clinical trials. This analysis describes patient characteristics, treatment patterns, outcomes, and safety profiles in patients with PoPH newly initiating macitentan in the USA using the OPUS/OrPHeUS combined dataset. METHODS OPUS was a prospective, US, multicenter, observational drug registry (April 2014-June 2020); OrPHeUS was a retrospective, US, multicenter chart review (October 2013-March 2017). Additional information regarding patients' liver disease was retrospectively collected for patients with PoPH in OPUS. RESULTS The OPUS/OrPHeUS dataset included 206 patients with PoPH (median age 58 years; 52.4% female), with baseline cirrhosis and liver test abnormalities reported in 72.8% and 31.6% of patients respectively. Macitentan was initiated as combination therapy in 74.8% of patients and median (Q1, Q3) exposure to macitentan was 11.9 (3.1, 26.0) months. One-year Kaplan-Meier estimates (95% confidence limit, CL) of patients free from all-cause hospitalization and survival were 48.6% (40.7, 56.0) and 82.2% (75.1, 87.4). Of the 96 patients with PoPH in OPUS, 29.2% were classified as in need of liver transplant due to underlying liver disease during the study; transplant waitlist registration was precluded because of PAH severity for 32.1% and 17.9% were transplanted. Hepatic adverse events (HAE) were experienced by 49.0% of patients; the most common being increased bilirubin (16.0%), ascites (7.3%), and hepatic encephalopathy (5.8%); 1.5% and 21.8% of patients discontinued macitentan as a result of HAE and non-hepatic adverse events. CONCLUSION There were no unexpected safety findings in patients with PoPH treated with macitentan. These data add to the evidence supporting the safety and tolerability of macitentan in patients with PoPH. A graphical abstract is available with this article. TRIAL REGISTRATION OPsumit® Users Registry (OPUS): NCT02126943; OPsumit® Historical Users cohort (OrPHeUS): NCT03197688; www. CLINICALTRIALS gov .
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Affiliation(s)
- Nick H Kim
- UC San Diego Health, Division of Pulmonary, Critical Care, and Sleep Medicine, University of California San Diego, 9300 Campus Point Dr, La Jolla, CA, 92037-7381, USA.
| | | | | | | | | | - Zeenat Safdar
- Houston Methodist, Weill Cornell Medical College, Houston, TX, USA
| | - Gwen MacDonald
- Global Medical Affairs, Actelion Pharmaceuticals Ltd, a Janssen Pharmaceutical Company of Johnson and Johnson, Allschwil, Switzerland
| | - Nicolas Martin
- Statistical Decision Science, Actelion Pharmaceuticals Ltd, a Janssen Pharmaceutical Company of Johnson and Johnson, Allschwil, Switzerland
| | - Daniel Rosenberg
- Global Epidemiology, Actelion Pharmaceuticals Ltd, a Janssen Pharmaceutical Company of Johnson and Johnson, Allschwil, Switzerland
| | - Maria Solonets
- Global Medical Safety, Actelion Pharmaceuticals Ltd, a Janssen Pharmaceutical Company of Johnson and Johnson, Allschwil, Switzerland
| | - Richard Channick
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
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Kiely DG, Channick R, Flores D, Galiè N, MacDonald G, Marcus JT, Mitchell L, Peacock A, Rosenkranz S, Tawakol A, Torbicki A, Vonk Noordegraaf A, Swift AJ. Comparison of cardiac magnetic resonance imaging, functional and haemodynamic variables in pulmonary arterial hypertension: insights from REPAIR. ERJ Open Res 2024; 10:00547-2023. [PMID: 38348238 PMCID: PMC10860210 DOI: 10.1183/23120541.00547-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 12/11/2023] [Indexed: 02/15/2024] Open
Abstract
Background Measures that can detect large treatment effects are important for monitoring therapeutic effectiveness. The 2022 European Society of Cardiology/European Respiratory Society guidelines highlight the importance of imaging in monitoring disease status and treatment response in pulmonary arterial hypertension (PAH). Are the standardised treatment effect sizes (STES) of cardiac magnetic resonance imaging (cMRI) comparable with functional and haemodynamic variables? Methods REPAIR (ClinicalTrials.gov: NCT02310672) was a prospective, multicentre, single-arm, open-label, 52-week phase 4 study evaluating the effect of macitentan 10 mg, with or without a phosphodiesterase 5 inhibitor (PDE5i), on right ventricular (RV) remodelling, cardiac function and cardiopulmonary haemodynamics. Both cMRI and functional assessments were performed at screening and at weeks 26 and 52; haemodynamic measurements were conducted at screening and week 26. In this post hoc analysis, STES were estimated using the parametric Cohen's d and non-parametric Cliff's delta tests. Results At week 26, large STES (Cohen's d) were observed for 10 of the 20 cMRI variables assessed, including the prognostic measures of RV and left ventricular stroke volume and RV ejection fraction and the haemodynamic trial end-point, pulmonary vascular resistance; medium STES were observed for 6-min walk distance (6MWD). The STES were consistent in treatment-naïve patients and those escalating therapy and maintained at week 52. Similar results were obtained using the non-parametric Cliff's delta method. Conclusions The treatment effect of macitentan, alone or in combination with a PDE5i, was comparable for several cMRI and haemodynamic variables with prognostic value in PAH, and greater than that of 6MWD in patients with PAH, highlighting the emerging relevance of cMRI in PAH.
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Affiliation(s)
- David G. Kiely
- Sheffield Pulmonary Vascular Disease Unit and NIHR Biomedical Research Centre, Royal Hallamshire Hospital and University of Sheffield, Sheffield, UK
- Department of Clinical Medicine, University of Sheffield, Sheffield, UK
| | | | - Dayana Flores
- Global Medical Affairs, Actelion Pharmaceuticals Ltd, a Janssen Pharmaceutical Company of Johnson & Johnson, Allschwil, Switzerland
| | - Nazzareno Galiè
- Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Dipartimento di Medicina Specialistica Diagnostica e Sperimentale (DIMES), Università di Bologna, Bologna, Italy
| | - Gwen MacDonald
- Global Medical Affairs, Actelion Pharmaceuticals Ltd, a Janssen Pharmaceutical Company of Johnson & Johnson, Allschwil, Switzerland
| | - J. Tim Marcus
- Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Lada Mitchell
- Statistical Decision Science, Actelion Pharmaceuticals Ltd, a Janssen Pharmaceutical Company of Johnson & Johnson, Allschwil, Switzerland
| | - Andrew Peacock
- Statistical Decision Science, Actelion Pharmaceuticals Ltd, a Janssen Pharmaceutical Company of Johnson & Johnson, Allschwil, Switzerland
| | | | - Ahmed Tawakol
- Department of Cardiology, Heart Center, University Hospital Cologne and Cologne Cardiovascular Research Center, University of Cologne, Cologne, Germany
| | - Adam Torbicki
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | | | - Andrew J. Swift
- Department of Clinical Medicine, University of Sheffield, Sheffield, UK
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Louw E, Baines N, Maarman G, Osman M, Sigwadhi L, Irusen E, Koegelenberg C, Doubell A, Nathan S, Channick R, Allwood B. The prevalence of pulmonary hypertension after successful tuberculosis treatment in a community sample of adult patients. Pulm Circ 2023; 13:e12184. [PMID: 36699148 PMCID: PMC9852678 DOI: 10.1002/pul2.12184] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 12/15/2022] [Accepted: 12/26/2022] [Indexed: 01/06/2023] Open
Abstract
There are an estimated 155 million survivors of tuberculosis (TB). Clinical experience suggests that post tuberculosis lung disease (PTLD) is an important cause of Group 3 pulmonary hypertension (PH). However, TB is not listed as a cause of PH in most guidelines. A cross-sectional, community-based study was conducted in nonhealthcare seeking adults who had successfully completed TB treatment. Subjects underwent questionnaires, spirometry, a 6-min walk distance test (6MWD) and transthoracic echocardiography (TTE). Screen probable PH was defined on TTE as an estimated pulmonary artery peak systolic pressure (PASP) of ≥40 mmHg. One hundred adults (71 males) were enrolled, with a mean age of 42 years (SD 13.8 years) and a median of one TB episode (interquartile range: 1-2). Co-morbidities included hypertension (21%), diabetes (16%), human immunodeficiency virus (10%) and asthma/COPD (5%). Only 25% had no residual symptoms after TB. Probable PH was found in 9%, while 7% had borderline raised PASP values (PASP 35-40 mmHg). An association was found between PH and the number of previous TB episodes, with each additional episode of TB increasing the odds of PH-postTB 2.13-fold (confidence interval [CI]: 1.17-3.88; p = 0.013). All of those found to have PH were smokers or ex-smokers yielding an unadjusted odds ratio for PH-postTB of 3.67 (95% CI: 0.77-17.46). There was no statistical difference in spirometry or 6MWD, between those with and without PH. Neither symptoms nor co-morbidities demonstrated significant association with PH. PH after TB was a common finding in this community-based population. Further research is needed to confirm and determine the significance of these findings.
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Affiliation(s)
- Elizabeth Louw
- Division of Pulmonology, Department of MedicineStellenbosch University & Tygerberg HospitalCape TownSouth Africa
| | - Nicola Baines
- Division of Pulmonology, Department of MedicineStellenbosch University & Tygerberg HospitalCape TownSouth Africa
| | - Gerald Maarman
- Division of Medical Physiology, Department of Biomedical Sciences, CARMA: Centre for Cardio‐Metabolic Research in Africa, Faculty of Medicine & Health SciencesStellenbosch UniversityStellenboschSouth Africa
| | - Muhammad Osman
- Department of Paediatrics and Child Health, Desmond Tutu TB CentreStellenbosch UniversityCape TownSouth Africa,Public Health, School of Human SciencesUniversity of GreenwichLondonUK
| | - Lovemore Sigwadhi
- Division of Epidemiology and BiostatisticsStellenbosch UniversityStellenboschSouth Africa,Division of StatisticsBiomedical Research and Training Institute, ZimbabweHarareZimbabwe
| | - Elvis Irusen
- Division of Pulmonology, Department of MedicineStellenbosch University & Tygerberg HospitalCape TownSouth Africa
| | - Coenraad Koegelenberg
- Division of Pulmonology, Department of MedicineStellenbosch University & Tygerberg HospitalCape TownSouth Africa
| | - Anton Doubell
- Division of Cardiology, Department of MedicineStellenbosch University & Tygerberg HospitalCape TownSouth Africa
| | - Steven Nathan
- The Advanced Lung Disease and Transplant ProgramInova Fairfax HospitalFalls ChurchVirginiaUSA
| | - Richard Channick
- Pulmonary and Critical Care DivisionDavid Geffen School of MedicineLos AngelesCaliforniaUSA
| | - Brian Allwood
- Division of Pulmonology, Department of MedicineStellenbosch University & Tygerberg HospitalCape TownSouth Africa
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Coghlan JG, Gaine S, Channick R, Chin KM, du Roure C, Gibbs JSR, Hoeper MM, Lang IM, Mathai SC, McLaughlin VV, Mitchell L, Simonneau G, Sitbon O, Tapson VF, Galiè N. Early selexipag initiation and long-term outcomes: insights from randomised controlled trials in pulmonary arterial hypertension. ERJ Open Res 2023; 9:00456-2022. [PMID: 36687361 PMCID: PMC9841313 DOI: 10.1183/23120541.00456-2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 10/03/2022] [Indexed: 11/12/2022] Open
Abstract
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.
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Affiliation(s)
- J. Gerry Coghlan
- Royal Free Hospital, London, UK,Corresponding author: J. Gerry Coghlan ()
| | - Sean Gaine
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - Richard Channick
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | | | - Camille du Roure
- Actelion Pharmaceuticals Ltd, a Janssen Pharmaceutical Company of Johnson & Johnson, Global Medical Affairs, Allschwil, Switzerland
| | - J. Simon R. Gibbs
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Marius M. Hoeper
- Department of Respiratory Medicine, Hannover Medical School and German Center for Lung Research, Hannover, Germany
| | - Irene M. Lang
- Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | | | | | - Lada Mitchell
- Actelion Pharmaceuticals Ltd, a Janssen Pharmaceutical Company of Johnson & Johnson, Statistics & Decision Sciences - Medical Affairs and Established Products, Allschwil, Switzerland
| | - Gérald Simonneau
- Hôpital Bicêtre, Université Paris-Sud, Le Kremlin Bicêtre, France
| | - Olivier Sitbon
- Hôpital Bicêtre, Université Paris-Sud, Le Kremlin Bicêtre, France
| | | | - Nazzareno Galiè
- Alma Mater Studiorum, University of Bologna and IRCCS-S.Orsola University Hospital, Bologna, Italy
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Agarwal MA, Dhaliwal JS, Yang EH, Aksoy O, Press M, Watson K, Ziaeian B, Fonarow GC, Moriarty JM, Saggar R, Channick R. Sex Differences in Outcomes of Percutaneous Pulmonary Artery Thrombectomy in Patients With Pulmonary Embolism. Chest 2023; 163:216-225. [PMID: 35926721 DOI: 10.1016/j.chest.2022.07.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/27/2022] [Accepted: 07/18/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The sex differences in use, safety outcomes, and health-care resource use of patients with pulmonary embolism (PE) undergoing percutaneous pulmonary artery thrombectomy are not well characterized. RESEARCH QUESTION What are the sex differences in outcomes for patients diagnosed with PE who undergo percutaneous pulmonary artery thrombectomy? STUDY DESIGN AND METHODS This retrospective cross-sectional study used national inpatient claims data to identify patients in the United States with a discharge diagnosis of PE who underwent percutaneous thrombectomy between January 2016 and December 2018. We evaluated the demographics, comorbidities, safety outcomes (in-hospital mortality), and health-care resource use (discharge to home, length of stay, and hospital charges) of patients with PE undergoing percutaneous thrombectomy. RESULTS Among 1,128,904 patients with a diagnosis of PE between 2016 and 2018, 5,160 patients (0.5%) underwent percutaneous pulmonary artery thrombectomy. When compared with male patients, female patients showed higher procedural bleeding (16.9% vs 11.2%; P < .05), required more blood transfusions (11.9% vs 5.7%; P < .05), and experienced more vascular complications (5.0% vs 1.5%; P < .05). Women experienced higher in-hospital mortality (16.9% vs 9.3%; adjusted OR, 1.9; 95% CI, 1.2-3.0; P = .003) when compared with men. Although length of stay and hospital charges were similar to those of men, women were less likely to be discharged home after surviving hospitalization (47.9% vs 60.3%; adjusted OR, 0.7; 95% CI, 0.50-0.99; P = .04). INTERPRETATION In this large nationwide cohort, women with PE who underwent percutaneous thrombectomy showed higher morbidity and in-hospital mortality compared with men.
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Affiliation(s)
- Manyoo A Agarwal
- Division of Cardiovascular Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA.
| | - Jasmeet S Dhaliwal
- Division of Cardiovascular Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Eric H Yang
- Division of Cardiovascular Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Olcay Aksoy
- Division of Cardiovascular Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Marcella Press
- Division of Cardiovascular Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Karol Watson
- Division of Cardiovascular Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Boback Ziaeian
- Division of Cardiovascular Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Gregg C Fonarow
- Division of Cardiovascular Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - John M Moriarty
- Division of Interventional Radiology, Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Rajan Saggar
- Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Richard Channick
- Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
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McLaughlin VV, Channick R, Kim NH, Frantz RP, McConnell J, Melendres‐Groves L, Miller C, Ravichandran A, Rodriguez‐Lopez J, Brand M, Leroy S, Wetherill G, Chin KM. Safety of macitentan for the treatment of pulmonary hypertension: Real‐world experience from the OPsumit® USers Registry (OPUS) and OPsumit® Historical USers cohort (OrPHeUS). Pulm Circ 2022; 12:e12150. [PMID: 36381290 PMCID: PMC9661363 DOI: 10.1002/pul2.12150] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 08/11/2022] [Accepted: 09/09/2022] [Indexed: 12/05/2022] Open
Abstract
Macitentan is an oral endothelin receptor antagonist for the management of pulmonary arterial hypertension (PAH). The OPsumit® USers Registry (OPUS) and the OPsumit® Historical USers cohort (OrPHeUS) medical chart review provide real‐world data for patients newly initiating macitentan. This study aims to describe the characteristics, safety profile, and clinical outcomes of PAH patients newly treated with macitentan in the combined OPUS/OrPHeUS data set. OPUS was a prospective, multicenter, long‐term, observational drug registry from April 2014 to June 2020. OrPHeUS was a retrospective, US, multicenter chart review: observation period October 2013 to March 2017. All analyses were descriptive. At registry closure in June 2020, the combined population consisted of 5654 patients, of whom 81.9% were diagnosed with PAH. For these 4626 patients, median duration of macitentan exposure observed was 14.5 (Q1 = 5.2, Q3 = 29.0) months; idiopathic PAH (54.8%) was the most common form of PAH; macitentan was initiated as monotherapy (37.9%), or as part of double (48.0%) or triple therapy (14.1%); discontinuation due to nonhepatic/hepatic adverse events occurred in 17.1%/0.3% of patients; 9.9% of patients experienced ≥1 hepatic adverse events; Kaplan–Meier estimates showed that at 1 year 59.9% (95% confidence interval: 58.3, 61.5) of patients were free from hospitalization and survival was 90.4% (89.3, 91.3). This analysis of real‐world data from the combined OPUS and OrPHeUS populations demonstrated that macitentan is well tolerated in a large, diverse population of PAH patients, with overall and hepatic safety profiles consistent with previous macitentan clinical trials.
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Affiliation(s)
- VV McLaughlin
- Department of Internal Medicine, Division of Cardiovascular Medicine University of Michigan Ann Arbor MI USA
| | - R Channick
- David Geffen School of Medicine University of California Los Angeles Los Angeles CA USA
| | - NH Kim
- Division of Pulmonary, Critical Care and Sleep Medicine University of California San Diego La Jolla CA USA
| | - RP Frantz
- Department of Cardiovascular Medicine Mayo Clinic Rochester MN USA
| | - J McConnell
- Kentuckiana Pulmonary Associates Louisville KY USA
| | | | - C Miller
- Pulmonary Hypertension and Pulmonary Critical Care Medicine, Piedmont Physicians, Piedmont Healthcare Austell GA USA
| | | | | | - M Brand
- Actelion Pharmaceuticals Ltd, a Janssen Pharmaceutical Company of Johnson and Johnson, Global Epidemiology Allschwil Switzerland
| | - S Leroy
- Actelion Pharmaceuticals Ltd, a Janssen Pharmaceutical Company of Johnson and Johnson, Data Science Global Regulatory Affairs Allschwil Switzerland
| | - G Wetherill
- Actelion Pharmaceuticals Ltd, a Janssen Pharmaceutical Company of Johnson and Johnson, Medical Affairs and Established Products Allschwil Switzerland
- Current affiliation: Biometric Solutions Limited, St Ives Cambridgeshire UK
| | - KM Chin
- Department of Internal Medicine, UT Southwestern Medical Center Dallas TX USA
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Channick R, Chin KM, Kim NH, Ong R, Turricchia S, Mitchell L, McLaughlin VV. Concomitant initiation of combination therapy with macitentan and tadalafil in pulmonary arterial hypertension (PAH) patients with comorbidities: real-world data from OPUS and OrPHeUS. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Guidelines for the management of pulmonary arterial hypertension (PAH) recommend early combination therapy of an endothelial receptor antagonist (ERA) and a phosphodiesterase type-5 inhibitor (PDE5i) [1]. There is, however, limited guidance about the management of PAH patients with comorbidities.
Purpose
To describe the demographics, clinical characteristics, safety, tolerability, and outcomes associated with initiation of the ERA macitentan and the PDE5i tadalafil in patients with comorbidities in the US OPsumit® USers (OPUS) and the OPsumit® Historical USers cohort (OrPHeUS) combined dataset.
Methods
This analysis reports data from the OPUS registry (Apr 2014–Jun 2020) and OrPHeUS medical chart review (Oct 2013–Mar 2017) on PAH patients initiating macitentan and tadalafil (M+T) combination therapy, in any order, as concomitant initiation (≤60 days apart, concomitant initiation group). The index date was defined as the start date of the second therapy (i.e., the start of combination therapy). Patients were further grouped by the number of comorbidities present prior to or at macitentan initiation: systemic hypertension, diabetes, renal insufficiency, BMI ≥30 kg/m2, other signs of right heart failure and atrial fibrillation. Results are presented descriptively alongside results for all PAH patients receiving M+T combination therapy (overall M+T group).
Results
Of the 1336 PAH patients that received M+T combination therapy, 431 (32%) were in the concomitant initiation group. In the concomitant initiation and overall M+T groups, respectively: 72% and 68% had ≥1 comorbidity, and the most common were systemic hypertension (47% and 47%), obesity (32% and 26%) and diabetes (23% and 22%). Patients were more likely to be older, male and have idiopathic/heritable PAH with increasing comorbidity burden (Table 1). Patients in the concomitant initiation group were more likely to be incident (median time from diagnosis: 1–2 months vs 9–24 months in the overall M+T group; Table 1). Most patients had ≥1 adverse event (AE); in both groups, patients with a high comorbidity burden (≥3) were more likely to have had an AE and to have discontinued treatment (Table 2). The incidence rate of first all-cause hospitalisation and mortality by comorbidity was comparable between the concomitant initiation and overall M+T groups.
Conclusions
In the real-world, concomitant initiation of M+T is used in PAH patients with comorbidities, usually shortly after diagnosis. Patient characteristics were similar for the concomitant initiation and overall M+T groups, with the exception of time from diagnosis. At index date, age, gender proportion, and PAH aetiology differed between the comorbidity groups. The safety profile of M+T combination therapy in the concomitant initiation group was consistent with that in the overall M+T group.
Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): Actelion Pharmaceuticals Ltd, a Janssen Pharmaceutical Company of Johnson & Johnson
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Affiliation(s)
- R Channick
- University of California Los Angeles , Los Angeles , United States of America
| | - K M Chin
- University of Texas Southwestern Medical Center , Dallas , United States of America
| | - N H Kim
- University of California San Diego , San Diego , United States of America
| | - R Ong
- Actelion Pharmaceuticals Ltd , Allschwil , Switzerland
| | - S Turricchia
- Actelion Pharmaceuticals Ltd , Allschwil , Switzerland
| | - L Mitchell
- Actelion Pharmaceuticals Ltd , Allschwil , Switzerland
| | - V V McLaughlin
- University of Michigan , Ann Arbor , United States of America
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Channick R, Robert Naeije. A Right Heart Catheterization for the Diagnosis of Pulmonary Hypertension. Chest 2022; 162:511-513. [DOI: 10.1016/j.chest.2022.04.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 04/27/2022] [Indexed: 10/14/2022] Open
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12
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Bravo-Jaimes K, Venkatesh P, Lluri G, Reardon L, Cruz D, Vucicevic D, Yang EH, Nsair A, Saggar R, Channick R, Kwon M, Van Arsdell G, Aboulhosn J. Temporary axial-flow mechanical circulatory support and intravenous treprostinil in a patient with D-transposition of the great arteries and atrial switch: A case report. International Journal of Cardiology Congenital Heart Disease 2022. [DOI: 10.1016/j.ijcchd.2022.100361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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13
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Galiè N, Gaine S, Channick R, Coghlan JG, Hoeper MM, Lang IM, McLaughlin VV, Lassen C, Rubin LJ, Hsu Schmitz SF, Sitbon O, Tapson VF, Chin KM. Long-Term Survival, Safety and Tolerability with Selexipag in Patients with Pulmonary Arterial Hypertension: Results from GRIPHON and its Open-Label Extension. Adv Ther 2022; 39:796-810. [PMID: 34727317 PMCID: PMC8799580 DOI: 10.1007/s12325-021-01898-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 08/19/2021] [Indexed: 01/29/2023]
Abstract
INTRODUCTION In the event-driven GRIPHON randomised-controlled trial, the oral prostacyclin receptor agonist selexipag significantly reduced the risk of disease progression (composite primary endpoint of morbidity/mortality), compared with placebo, in patients with pulmonary arterial hypertension (PAH). The ongoing open-label extension study (GRIPHON OL) collects further data on long-term safety, tolerability, and survival of PAH patients treated with selexipag. METHODS Patients randomised to selexipag or placebo in GRIPHON could enter GRIPHON OL either after experiencing a morbidity event during double-blind treatment or at the end of the study. Patients were followed for adverse events (AE) and survival from selexipag initiation up to 3 days and 30 days after end of treatment, respectively. Data are presented up to a cut-off date of 1 September 2019. RESULTS Overall, 953 patients in GRIPHON and GRIPHON OL were treated with selexipag. At the time of selexipag initiation, 81.2% of patients were receiving background PAH therapy. Median (min, max) exposure to selexipag was 31.7 months (0, 106), corresponding to a total of 3054.4 patient-years. The most frequently reported AEs were related to known prostacyclin-related effects or underlying disease. There were 305 (32.0%) patients who experienced an AE leading to treatment discontinuation. Survival during GRIPHON and GRIPHON OL was assessed for the 574 patients randomised to selexipag in GRIPHON. Kaplan-Meier survival estimates (95%CI) at 1, 3, 5 and 7 years were 92.0% (89.4, 94.0), 79.3% (75.4, 82.6), 71.2% (66.5, 75.3) and 63.0% (57.4, 68.1), respectively. CONCLUSIONS These results provide the longest follow-up period published to date for a PAH therapy. The safety profile of selexipag over this extended treatment period was consistent with that observed in GRIPHON. A large proportion of the population was receiving background therapy at selexipag initiation, providing further insight into the long-term safety of selexipag as part of a combination therapy regimen. TRIAL REGISTRATION ClinicalTrials.gov Identifiers: NCT01106014 and NCT01112306.
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Affiliation(s)
- Nazzareno Galiè
- Alma Mater Studiorum, University of Bologna and IRCCS-S.Orsola University Hospital, Via Massarenti, 9, 40138, Bologna, Italy.
| | - Sean Gaine
- Mater Misericordiae University Hospital, Dublin, Ireland
| | | | | | - Marius M Hoeper
- Hannover Medical School and German Centre for Lung Research (DZL/BREATH), Hannover, Germany
| | | | | | - Cheryl Lassen
- Actelion Pharmaceuticals Ltd, Allschwil, Switzerland
| | | | | | - Olivier Sitbon
- Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- Université Paris-Sud, Le Kremlin-Bicêtre, France
- INSERM Unité 999, Le Plessis Robinson, France
| | | | - Kelly M Chin
- University of Texas Southwestern Medical Center, Dallas, USA
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Rosenkranz S, Channick R, Chin KM, Jenner B, Gaine S, Galiè N, Ghofrani HA, Hoeper MM, McLaughlin VV, Du Roure C, Rubin LJ, Sitbon O, Tapson V, Lang IM. The impact of comorbidities on selexipag treatment effect in patients with pulmonary arterial hypertension: insights from the GRIPHON study. Eur J Heart Fail 2021; 24:205-214. [PMID: 34806261 PMCID: PMC9298818 DOI: 10.1002/ejhf.2369] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 09/23/2021] [Accepted: 10/17/2021] [Indexed: 11/23/2022] Open
Abstract
Aims The number of pulmonary arterial hypertension (PAH) patients with comorbidities is increasing and there are limited data on response to PAH‐targeted therapies in this population. These post hoc analyses explored the effect of selexipag in PAH patients with cardiovascular comorbidities in the GRIPHON study. Methods and results Randomized patients (n = 1156) were classified using three methods: (i) by subgroups defined according to previously published comorbidity count and restrictive haemodynamic criteria: Subgroup A (<3 comorbidities and haemodynamic criteria met; n = 962) and Subgroup B (≥3 comorbidities and/or haemodynamic criteria not met; n = 144); comorbidities included body mass index ≥30 kg/m2, essential hypertension, diabetes, history of coronary artery disease; (ii) by number of comorbidities, with addition of atrial fibrillation (0, 1, 2, 3, 4, or 5); (iii) by presence of individual comorbidities. Selexipag to placebo hazard ratios (HR) and 95% confidence intervals (CI) for morbidity/mortality (primary composite endpoint) were estimated using Cox regression adjusting selexipag effect for baseline covariates. Approximately half of the patients in GRIPHON (n = 584; 50.5%) had comorbidities. Selexipag reduced the risk of a morbidity/mortality event compared with placebo in both Subgroup A (HR 0.66, 95% CI 0.53, 0.82) and Subgroup B (HR 0.50, 95% CI 0.26, 0.96), with no evidence of an inconsistent treatment effect between subgroups (interaction p = 0.432). Consistent results were observed in analyses by number and by specific type of comorbidity. Conclusion Selexipag reduces the risk of a morbidity/mortality event vs. placebo irrespective of patient comorbidity status, suggesting that comorbidity status does not influence the treatment effect of selexipag.
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Affiliation(s)
- Stephan Rosenkranz
- Heart Center, University Hospital Cologne, and Cologne Cardiovascular Research Center (CCRC), Cologne, Germany
| | | | | | | | - Sean Gaine
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - Nazzareno Galiè
- DIMES, University of Bologna and IRCCS, S. Orsola University Hospital, Bologna, Italy
| | - Hossein-Ardeschir Ghofrani
- University of Giessen and Marburg Lung Center, Giessen, Germany, member of the German Center for Lung Research, and Department of Medicine, Imperial College London, London, UK
| | - Marius M Hoeper
- Department of Respiratory Medicine, Hannover Medical School and German Center for Lung Research, Hannover, Germany
| | | | | | - Lewis J Rubin
- Division of Pulmonary and Critical Care Medicine, University of California, San Diego, CA, USA
| | - Olivier Sitbon
- Hôpital Universitaire de Bicêtre, Université Paris-Sud, Le Kremlin Bicêtre, France
| | | | - Irene M Lang
- Division of Cardiology, Medical University of Vienna, Vienna, Austria
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Vonk Noordegraaf A, Channick R, Cottreel E, Kiely DG, Marcus JT, Martin N, Moiseeva O, Peacock A, Swift AJ, Tawakol A, Torbicki A, Rosenkranz S, Galiè N. The REPAIR Study: Effects of Macitentan on RV Structure and Function in Pulmonary Arterial Hypertension. JACC Cardiovasc Imaging 2021; 15:240-253. [PMID: 34801462 DOI: 10.1016/j.jcmg.2021.07.027] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 07/02/2021] [Accepted: 07/29/2021] [Indexed: 01/29/2023]
Abstract
OBJECTIVES The REPAIR (Right vEntricular remodeling in Pulmonary ArterIal hypeRtension) study evaluated the effect of macitentan on right ventricular (RV) and hemodynamic outcomes in patients with pulmonary arterial hypertension (PAH), using cardiac magnetic resonance (CMR) and right heart catheterization (RHC). BACKGROUND RV failure is the primary cause of death in PAH. CMR is regarded as the most accurate noninvasive method for assessing RV function and remodeling and CMR measures of RV function and structure are strongly prognostic for survival in patients with PAH. Despite this, CMR is not routinely used in PAH clinical trials. METHODS REPAIR was a 52-week, open-label, single-arm, multicenter, phase 4 study evaluating the effect of macitentan 10 mg, with or without phosphodiesterase type-5 inhibition, on RV remodeling and function and cardiopulmonary hemodynamics. Primary endpoints were change from baseline to week 26 in RV stroke volume, determined by CMR; and pulmonary vascular resistance, determined by RHC. Efficacy measures were assessed for all patients with baseline and week 26 data for both primary endpoints. RESULTS At a prespecified interim analysis in 42 patients, both primary endpoints were met, enrollment was stopped, and the study was declared positive. At final analysis (n = 71), RV stroke volume increased by 12 mL (96% confidence level: 8.4-15.6 mL; P < 0.0001) and pulmonary vascular resistance decreased by 38% (99% confidence level: 31%-44%; P < 0.0001) at week 26. Significant positive changes were also observed in secondary and exploratory CMR (RV and left ventricular), hemodynamic, and functional endpoints at week 26. Improvements in CMR RV and left ventricular variables and functional parameters were maintained at week 52. Safety (n = 87) was consistent with previous clinical trials. CONCLUSIONS In the context of this study, macitentan treatment in patients with PAH resulted in significant and clinically-relevant improvements in RV function and structure and cardiopulmonary hemodynamics. At 52 weeks, improvements in RV function and structure were sustained. (REPAIR: Right vEntricular remodeling in Pulmonary ArterIal hypeRtension [REPAIR]; NCT02310672).
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Affiliation(s)
| | - Richard Channick
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | | | - David G Kiely
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - J Tim Marcus
- Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | | | - Olga Moiseeva
- Almazov National Medical Research Centre, St. Petersburg, Russia
| | - Andrew Peacock
- Scottish Pulmonary Vascular Unit, Glasgow, United Kingdom
| | - Andrew J Swift
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Ahmed Tawakol
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Adam Torbicki
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, ECZ-Otwock, Otwock, Poland
| | - Stephan Rosenkranz
- Department of Cardiology, Heart Center at the University of Cologne, and Cologne Cardiovascular Research Center (CCRC), Cologne, Germany
| | - Nazzareno Galiè
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Bologna, Italy
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Rali P, Sacher D, Rivera-Lebron B, Rosovsky R, Elwing JM, Berkowitz J, Mina B, Dalal B, Davis GA, Dudzinski DM, Duval A, Ichinose E, Kabrhel C, Kapoor A, Lio KU, Lookstein R, McDaniel M, Melamed R, Naydenov S, Sokolow S, Rosenfield K, Tapson V, Bossone E, Keeling B, Channick R, Ross CB. Interhospital Transfer of Patients With Acute Pulmonary Embolism (PE): Challenges and Opportunities. Chest 2021; 160:1844-1852. [PMID: 34273391 DOI: 10.1016/j.chest.2021.07.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 06/23/2021] [Accepted: 07/02/2021] [Indexed: 01/07/2023] Open
Abstract
Acute pulmonary embolism (PE) is associated with significant morbidity and mortality. The management paradigm for acute PE has evolved in recent years with wider availability of advanced treatment modalities ranging from catheter-directed reperfusion therapies to mechanical circulatory support. This evolution has coincided with the development and implementation of institutional pulmonary embolism response teams (PERT) nationwide and internationally. Because most institutions are not equipped or staffed for advanced PE care, patients often require transfer to centers with more comprehensive resources, including PERT expertise. One of the unmet needs in current PE care is an organized approach to the process of interhospital transfer (IHT) of critically ill PE patients. In this review, we discuss medical optimization and support of patients before and during transfer, transfer checklists, defined roles of emergency medical services, and the roles and responsibilities of referring and receiving centers involved in the IHT of acute PE patients.
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Affiliation(s)
- Parth Rali
- Temple University Hospital, Philadelphia, PA.
| | | | | | - Rachel Rosovsky
- Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Jean M Elwing
- University of Cincinnati College of Medicine, Cincinnati, OH
| | | | | | - Bhavinkumar Dalal
- Oakland University William Beaumont School of Medicine, Royal Oak, MI
| | | | | | | | | | | | | | - Ka U Lio
- Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | | | | | | | | | | | | | | | | | | | | | - Charles B Ross
- Piedmont Heart Institute, Piedmont Atlanta Hospital, Atlanta, GA
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17
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Lammi M, Channick R, Chin K, Kim N, Ong R, Rocco M, Wetherill G, McLaughlin V. CHARACTERISTICS AND OUTCOMES OF PATIENTS WITH MILDLY-ELEVATED PRESSURES (MEP) AND PATIENTS WITH PULMONARY ARTERIAL HYPERTENSION (PAH): INSIGHTS FROM OPUS/ORPHEUS. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)03031-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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18
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Wang J, Shahid M, Jaffe G, Mukku R, Harrell J, Channick R, Yang E. HOW HIGH IS TOO HIGH? ELEVATED TROPONIN IN A PATIENT WITH CONCOMITANT PULMONARY EMBOLISM AND ACUTE CORONARY SYNDROME. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)03881-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Hong J, Arneson D, Umar S, Ruffenach G, Cunningham CM, Ahn IS, Diamante G, Bhetraratana M, Park JF, Said E, Huynh C, Le T, Medzikovic L, Humbert M, Soubrier F, Montani D, Girerd B, Trégouët DA, Channick R, Saggar R, Eghbali M, Yang X. Single-Cell Study of Two Rat Models of Pulmonary Arterial Hypertension Reveals Connections to Human Pathobiology and Drug Repositioning. Am J Respir Crit Care Med 2021; 203:1006-1022. [PMID: 33021809 PMCID: PMC8048757 DOI: 10.1164/rccm.202006-2169oc] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 10/06/2020] [Indexed: 12/14/2022] Open
Abstract
Rationale: The cellular and molecular landscape and translational value of commonly used models of pulmonary arterial hypertension (PAH) are poorly understood. Single-cell transcriptomics can enhance molecular understanding of preclinical models and facilitate their rational use and interpretation.Objectives: To determine and prioritize dysregulated genes, pathways, and cell types in lungs of PAH rat models to assess relevance to human PAH and identify drug repositioning candidates.Methods: Single-cell RNA sequencing was performed on the lungs of monocrotaline (MCT), Sugen-hypoxia (SuHx), and control rats to identify altered genes and cell types, followed by validation using flow-sorted cells, RNA in situ hybridization, and immunofluorescence. Relevance to human PAH was assessed by histology of lungs from patients and via integration with human PAH genetic loci and known disease genes. Candidate drugs were predicted using Connectivity Map.Measurements and Main Results: Distinct changes in genes and pathways in numerous cell types were identified in SuHx and MCT lungs. Widespread upregulation of NF-κB signaling and downregulation of IFN signaling was observed across cell types. SuHx nonclassical monocytes and MCT conventional dendritic cells showed particularly strong NF-κB pathway activation. Genes altered in SuHx nonclassical monocytes were significantly enriched for PAH-associated genes and genetic variants, and candidate drugs predicted to reverse the changes were identified. An open-access online platform was developed to share single-cell data and drug candidates (http://mergeomics.research.idre.ucla.edu/PVDSingleCell/).Conclusions: Our study revealed the distinct and shared dysregulation of genes and pathways in two commonly used PAH models for the first time at single-cell resolution and demonstrated their relevance to human PAH and utility for drug repositioning.
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Affiliation(s)
- Jason Hong
- Division of Pulmonary and Critical Care Medicine
| | | | - Soban Umar
- Department of Anesthesiology and Perioperative Medicine, and
| | | | | | - In Sook Ahn
- Department of Integrative Biology and Physiology
| | | | - May Bhetraratana
- Division of Cardiology, University of California Los Angeles, Los Angeles, California
| | - John F. Park
- Department of Anesthesiology and Perioperative Medicine, and
| | - Emma Said
- Department of Anesthesiology and Perioperative Medicine, and
| | | | - Trixie Le
- Department of Anesthesiology and Perioperative Medicine, and
| | | | - Marc Humbert
- Department of Respiratory and Intensive Care Medicine, Bicêtre Hospital, University of Paris-Saclay, National Institute of Health and Medical Research Joint Research Unit S 999, Public Assistance Hospitals of Paris, Le Kremlin-Bicêtre, France
| | - Florent Soubrier
- Institut Hospitalo–Universitaire Cardiométabolisme et Nutrition, Paris, France; and
| | - David Montani
- Department of Respiratory and Intensive Care Medicine, Bicêtre Hospital, University of Paris-Saclay, National Institute of Health and Medical Research Joint Research Unit S 999, Public Assistance Hospitals of Paris, Le Kremlin-Bicêtre, France
| | - Barbara Girerd
- Department of Respiratory and Intensive Care Medicine, Bicêtre Hospital, University of Paris-Saclay, National Institute of Health and Medical Research Joint Research Unit S 999, Public Assistance Hospitals of Paris, Le Kremlin-Bicêtre, France
| | - David-Alexandre Trégouët
- Bordeaux Population Health Research Center, University of Bordeaux, National Institute of Health and Medical Research Joint Research Unit 1219, Bordeaux, France
| | | | - Rajan Saggar
- Division of Pulmonary and Critical Care Medicine
| | | | - Xia Yang
- Department of Integrative Biology and Physiology
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Sahay S, Channick R, Chin K, McLaughlin V, Agron P, Ong R, Wetherill G, Kim N. Macitentan in Pulmonary Hypertension (PH) Due to Chronic Lung Disease: Real-World Evidence from OPUS/OrPHeUS. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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21
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Rosovsky RP, Grodzin C, Channick R, Davis GA, Giri JS, Horowitz J, Kabrhel C, Lookstein R, Merli G, Morris TA, Rivera-Lebron B, Tapson V, Todoran TM, Weinberg AS, Rosenfield K. Diagnosis and Treatment of Pulmonary Embolism During the Coronavirus Disease 2019 Pandemic: A Position Paper From the National PERT Consortium. Chest 2020; 158:2590-2601. [PMID: 32861692 PMCID: PMC7450258 DOI: 10.1016/j.chest.2020.08.2064] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 08/06/2020] [Accepted: 08/16/2020] [Indexed: 12/22/2022] Open
Abstract
The coexistence of coronavirus disease 2019 (COVID-19) and pulmonary embolism (PE), two life-threatening illnesses, in the same patient presents a unique challenge. Guidelines have delineated how best to diagnose and manage patients with PE. However, the unique aspects of COVID-19 confound both the diagnosis and treatment of PE, and therefore require modification of established algorithms. Important considerations include adjustment of diagnostic modalities, incorporation of the prothrombotic contribution of COVID-19, management of two critical cardiorespiratory illnesses in the same patient, and protecting patients and health-care workers while providing optimal care. The benefits of a team-based approach for decision-making and coordination of care, such as that offered by pulmonary embolism response teams (PERTs), have become more evident in this crisis. The importance of careful follow-up care also is underscored for patients with these two diseases with long-term effects. This position paper from the PERT Consortium specifically addresses issues related to the diagnosis and management of PE in patients with COVID-19.
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Affiliation(s)
| | - Charles Grodzin
- Emory University Hospital Midtown, Emory University, Atlanta, GA
| | - Richard Channick
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | | | - Jay S Giri
- Hospital of the University of Pennsylvania, Philadelphia, PA
| | | | | | | | - Geno Merli
- Thomas Jefferson University Hospitals, Philadelphia, PA
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22
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Labin JE, Saggar R, Yang EH, Lluri G, Sayah D, Channick R, Ardehali A, Aksoy O, Parikh RV. Left main coronary artery compression in pulmonary hypertension. Catheter Cardiovasc Interv 2020; 97:E956-E966. [PMID: 33241630 DOI: 10.1002/ccd.29401] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/06/2020] [Accepted: 11/14/2020] [Indexed: 11/07/2022]
Abstract
Extrinsic compression of the left main coronary artery (LMCA) by a dilated pulmonary artery (PA) in the setting of pulmonary arterial hypertension (PAH) is an increasingly recognized disease entity. LMCA compression has been associated with angina, arrhythmia, heart failure, and sudden cardiac death in patients with PAH. Recent studies suggest that at least 6% of patients with PAH have significant LMCA compression. Screening for LMCA compression can be achieved with computed coronary tomography angiography, with a particular emphasis on assessment of PA size and any associated downward displacement and reduced takeoff angle of the LMCA. Indeed, evidence of a dilated PA (>40 mm), a reduced LMCA takeoff angle (<60°), and/or LMCA stenosis on CCTA imaging should prompt further diagnostic evaluation. Coronary angiography in conjunction with intravascular imaging has proven effective in diagnosing LMCA compression and guiding subsequent treatment. While optimal medical therapy and surgical correction remain in the clinician's arsenal, percutaneous coronary intervention has emerged as an effective treatment for LMCA compression. Given the prevalence of LMCA compression, its associated morbidity, and mortality, and the wide array of successful treatment strategies, maintaining a high degree of suspicion for this condition, and understanding the potential treatment strategies is critical.
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Affiliation(s)
- Jonathan E Labin
- Department of Medicine, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California, USA
| | - Rajan Saggar
- Division of Pulmonary and Critical Care, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California, USA
| | - Eric H Yang
- Division of Cardiology, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California, USA
| | - Gentian Lluri
- Division of Cardiology, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California, USA
| | - David Sayah
- Division of Pulmonary and Critical Care, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California, USA
| | - Richard Channick
- Division of Pulmonary and Critical Care, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California, USA
| | - Abbas Ardehali
- Division of Cardiothoracic Surgery, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California, USA
| | - Olcay Aksoy
- Division of Cardiology, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California, USA
| | - Rushi V Parikh
- Division of Cardiology, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California, USA
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23
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Johnson SW, Witkin A, Rodriguez-Lopez J, Channick R. Room for improvement in pulmonary capillary wedge pressure reporting: a review of hemodynamic tracings at a large academic medical center. Pulm Circ 2020; 10:2045894020929157. [PMID: 33240481 PMCID: PMC7672742 DOI: 10.1177/2045894020929157] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Accepted: 05/01/2020] [Indexed: 01/06/2023] Open
Abstract
To describe the frequency with which pulmonary capillary wedge pressure measurements, obtained during right heart catheterization, are falsely elevated and to educate operators on techniques to improve accuracy of pulmonary capillary wedge pressure reporting. Failure to completely occlude pulmonary artery branch vessels during balloon inflation can lead to falsely elevated, “incomplete” pulmonary capillary wedge pressures. Balloon deflation prior to catheter retraction may result in catheter advancement into smaller branch vessels, yielding an inadvertent but more accurate alternative pulmonary capillary wedge pressure. We hypothesized that this phenomenon can be identified on retrospective review of right heart catheterization tracings, which occurs commonly and goes unrecognized by operators. We conducted a retrospective study of patients undergoing right heart catheterization or right heart catheterization and left heart catheterization with computer-generated pulmonary capillary wedge pressure ≥20 from January 2015 to June 2017. Alternative pulmonary capillary wedge pressures were defined as a pulmonary capillary wedge pressure trace during balloon deflation ≥3 mmHg lower than the reported pulmonary capillary wedge pressure. Inter-rater reliability of tracing reviewers was also evaluated. Results showed that, of the 182 tracings reviewed, an alternative pulmonary capillary wedge pressure was identified in 26 or 14.3% of cases. Eleven of these alternative pulmonary capillary wedge pressures were ≤15 mmHg with a calculated pulmonary vascular resistance ≥3 Wood units in 10 patients, re-classifying the etiology of pulmonary hypertension from post-capillary to pre-capillary in 38.5% of cases. For the eight patients for whom left heart catheterization data were available, left ventricular end-diastolic pressure aligned with the alternative pulmonary capillary wedge pressure. In conclusion, inadvertently obtained, but likely more accurate, alternative pulmonary capillary wedge pressures were identified in almost 15% of procedures reviewed from a busy academic institution. As wedge pressures often drive diagnosis and treatment decisions for patients with cardiac and pulmonary pathology, operators should be attuned to balloon deflation as a time when alternative pulmonary capillary wedge pressures may be identified as they are likely more reflective of left ventricular end-diastolic pressure. Additional tools to ensure accuracy of pulmonary capillary wedge pressure reporting are reviewed.
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Affiliation(s)
- Shelsey W Johnson
- Department of Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Alison Witkin
- Department of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Josanna Rodriguez-Lopez
- Department of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Richard Channick
- Department of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA
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McLaughlin V, Chin K, Kim N, Flynn M, Ong R, Wetherill G, Channick R. Treatment with macitentan for pulmonary arterial hypertension (PAH) associated with congenital heart disease (CHD): real-world experience from the combined OPUS and OrPHeUS data sets. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Restrictive inclusion criteria can exclude some CHD-PAH patients from clinical trials. The OPsumit® USers (OPUS) Registry and the OPsumit® Historical USers (OrPHeUS) data sets provide real-world data in PAH patients newly started on macitentan, including patients with CHD-PAH regardless of defect type.
Purpose
To describe the characteristics, safety and clinical outcomes of CHD-PAH patients newly treated with macitentan.
Methods
OPUS is a prospective, US, multicentre, observational drug registry ongoing since April 2014. OrPHeUS was a retrospective, US, multicentre chart review; observation period Oct 2013–Mar 2017. This analysis reports information on CHD-PAH patients in the combined OPUS/OrPHeUS data set, descriptively compared with idiopathic/heritable PAH (I/HPAH) patients.
Results
As of Sept 2019, there were 4268 PAH patients with follow-up data, of whom 264 (6%) had CHD-PAH and 2396 (56%) had I/HPAH. For CHD-PAH and I/HPAH patients respectively at macitentan initiation: median age (Q1, Q3) was 48 (36, 62) and 65 (53, 73) years; 199 (75%) and 1748 (73%) were female; 67/114 (59%) and 802/1301 (62%) were WHO functional class III/IV; median (Q1, Q3) 6-minute walk distances were 350 (274, 420) and 289 (195, 375) m for the 82 and 840 patients with measurements; median (Q1, Q3) time from PAH diagnosis to macitentan initiation was 37.3 (4.5, 113.1) and 7.4 (1.4, 38.3) months; and 99 (38%) and 1056 (44%) initiated macitentan as monotherapy. The number of patients with ≥1 hepatic adverse event (HAE) was similar for CHD-PAH and I/HPAH (22 [8%] and 184 [8%]), as were the adverse event (AE) profiles (collected from OPUS only). Exposure, discontinuations, outcomes and most common AEs are shown in the table.
Conclusions
In general, compared with I/HPAH patients, CHD-PAH patients were younger and a greater proportion had prevalent disease than I/HPAH patients. Safety and outcomes were similar between the groups.
Funding Acknowledgement
Type of funding source: Other. Main funding source(s): Actelion Pharmaceuticals Ltd
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Affiliation(s)
- V McLaughlin
- University of Michigan, Division of Cardiovascular Medicine, Ann Arbor, United States of America
| | - K Chin
- University of Texas Southwestern Medical Center, Dallas, United States of America
| | - N.H Kim
- University of California San Diego, San Diego, United States of America
| | - M Flynn
- Actelion Pharmaceuticals US, Inc., South San Francisco, United States of America
| | - R Ong
- Actelion Pharmaceuticals Ltd, Allschwil, Switzerland
| | - G Wetherill
- Actelion Pharmaceuticals Ltd, Allschwil, Switzerland
| | - R Channick
- David Geffen School of Medicine at UCLA, Los Angeles, United States of America
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Rosenkranz S, Channick R, Cottreel E, Galie N, Kiely D, Marcus J, Swift A, Tawakol A, Torbicki A, Vonk Noordegraaf A, Wetherill G, Peacock A. Effect of macitentan on left ventricular (LV) function in pulmonary arterial hypertension (PAH): results from REPAIR. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
PAH impacts right ventricular (RV) structure and function but also leads to changes in the LV due to RV/LV interaction and underfilling. REPAIR, the first PAH study to use a primary endpoint assessed by cardiac MRI (cMRI), reported that RV stroke volume (RVSV) increased by 12 mL and pulmonary vascular resistance (PVR) decreased by 38% from baseline (BL) to Week 26 with macitentan.
Purpose
To assess the effect of macitentan on LV function in patients with PAH.
Methods
REPAIR (NCT02310672) was a 52-week, multicentre, open-label, single-arm, phase 4 study assessing the effect of macitentan primarily on RV structure and function, determined by cMRI and right heart catheterisation. Macitentan 10 mg was initiated in treatment-naïve patients, in patients receiving stable background phosphodiesterase type-5 inhibitor (PDE5i) at BL, or in initial combination with PDE5i. Exploratory LV endpoints were assessed by cMRI at Weeks 26 and 52. Safety was assessed up to end of study treatment +30 days in all patients who received ≥1 dose of macitentan (N=87). Patients with BL and Week 26 assessments for both PVR and RVSV were included in the modified Full Analysis Set (mFAS; N=71).
Results
In the mFAS, 57 (80%) patients were female. At BL, median age was 45 years; median (Q1, Q3) six-minute walk distance was 395 (323, 483) m; 48%/51% of patients were WHO functional class II/III; 59% had idiopathic PAH. Compared to BL, at Weeks 26 and 52 there were significant changes in LV cMRI parameters (table). The most common AEs were peripheral oedema (22%), headache (21%) and dizziness (14%).
Conclusions
Macitentan led to improvements in LV mass, volume and function, including clinically-relevant increases in LV stroke volume, at both 26 and 52 weeks in patients with PAH. Safety was consistent with other macitentan clinical trial data.
Funding Acknowledgement
Type of funding source: Other. Main funding source(s): Actelion Pharmaceuticals Ltd
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Affiliation(s)
- S Rosenkranz
- Heart Center at the University of Cologne, and Cologne Cardiovascular Research Center (CCRC), Cologne, Germany
| | - R Channick
- David Geffen School of Medicine at UCLA, Los Angeles, United States of America
| | - E Cottreel
- Actelion Pharmaceuticals Ltd, Allschwil, Switzerland
| | - N Galie
- Department of Experimental, Diagnostic and Specialty Medicine – DIMES, University of Bologna, Bologna, Italy
| | - D.G Kiely
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - J.T Marcus
- Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands (The)
| | - A.J Swift
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - A Tawakol
- Massachusetts General Hospital - Harvard Medical School, Boston, United States of America
| | - A Torbicki
- Department of Pulmonary Circulation CMKP, European Health Center, Otwock, Poland
| | - A Vonk Noordegraaf
- Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands (The)
| | - G Wetherill
- Actelion Pharmaceuticals Ltd, Allschwil, Switzerland
| | - A Peacock
- Scottish Pulmonary Vascular Unit, Glasgow, United Kingdom
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26
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McLaughlin V, Channick R, Kim N, Flynn M, Leroy S, Wetherill G, Chin K. Combination therapy with macitentan and phosphodiesterase type-5 inhibitor (PDE5i) in pulmonary arterial hypertension (PAH): real-world data from OPUS and OrPHeUS. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Guidelines for the management of PAH recommend combination therapy for most patients, yet real-world data on treatment patterns in PAH are limited.
Purpose
To describe the characteristics, safety and clinical outcomes of PAH patients newly treated with double combination therapy with macitentan and PDE5i in the OPsumit® USers (OPUS) Registry and the OPsumit® Historical USers cohort study (OrPHeUS) combined dataset.
Methods
OPUS is a prospective, US, multicentre, observational drug registry (NCT02126943) ongoing since April 2014. OrPHeUS was a retrospective, US, multicentre chart review (NCT03197688); Oct 2013–Mar 2017. This cohort included patients initiating combination therapy with macitentan and a PDE5i (in any order) ≤60 days apart. Baseline was defined as the start date of the second therapy (i.e., start of combination therapy). Patient characteristics at baseline, changes in 6-minute walk distance (6MWD) and WHO functional class (FC) from baseline to follow-up, safety and outcomes are described.
Results
Of the 4428 OPUS/OrPHeUS PAH patients initiating macitentan, 2490 received this in combination with a PDE5i; of these patients, 740 (29.7%) initiated macitentan and a PDE5i concurrently (≤60 days apart). Data on disease duration was recorded in 729 patients at baseline; of these, 588 (80.7%) patients were incident (≤6 months since diagnosis) and 141 (19.3%) were prevalent (>6 months since diagnosis); median time from diagnosis to start of combination therapy of was 1.4 (Q1=0.6, Q3=3.6) months. At baseline, median age was 60 (Q1=49, Q3=70) years and 73.6% of patients were female. Mean baseline 6MWD was 264.5 (SD=119.8) m, recorded in 240 (32.4%) patients. WHO FC was recorded at baseline for 347 (46.9%) patients; 263 (75.8%) were in FC III/IV. Median combination therapy exposure was 10.2 (Q1=3.4, Q3=21.8) months, with 58.8% of patients ongoing at data cut. Changes from baseline to follow up in FC and 6MWD are shown in the figure. There was ≥1 adverse event (AE) reported in 455 (61.5%) patients and ≥1 hepatic AE (HAE) in 76 (10.3%) patients. In total, 232 (31.4%) patients discontinued macitentan; 122 (16.5%) due to AEs, 4 (0.5%) due to HAEs, 98 (13.2%) not due to an AE/HAE, and 8 (1.1%) for unknown reasons. Of the 305 patients who discontinued combination therapy, 137 (18.5%) discontinued macitentan only, 73 (9.9%) discontinued PDE5i only, and 95 (12.8%) discontinued both drugs at the same time. Kaplan-Meier estimates (95% CI) showed that 60.7% (56.4, 64.8) of patients were free from hospitalisation and 88.7% (85.7, 91.1) were alive at 12 months.
Conclusions
In this real-world setting, less than one third of patients treated with macitentan received initial oral combination therapy, despite current expert consensus favouring such therapeutic approaches. Patients initiating macitentan+PDE5i ≤60 days apart had improved 6MWD and WHO FC from baseline to follow-up.
Funding Acknowledgement
Type of funding source: Other. Main funding source(s): Actelion Pharmaceuticals Ltd
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Affiliation(s)
- V McLaughlin
- University of Michigan, Division of Cardiovascular Medicine, Ann Arbor, United States of America
| | - R Channick
- David Geffen School of Medicine at UCLA, Los Angeles, United States of America
| | - N.H Kim
- University of California San Diego, San Diego, United States of America
| | - M Flynn
- Actelion Pharmaceuticals US, Inc., South San Francisco, United States of America
| | - S Leroy
- Actelion Pharmaceuticals Ltd, Allschwil, Switzerland
| | - G Wetherill
- Actelion Pharmaceuticals Ltd, Allschwil, Switzerland
| | - K Chin
- University of Texas Southwestern Medical Center, Dallas, United States of America
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Torbicki A, Channick R, Cottreel E, Galie N, Kiely D, Marcus JT, Moceri P, Peacock A, Rosenkranz S, Swift A, Noordegraaf AV, Wetherill G, Tawakol A. EFFECT OF MACITENTAN ON CARDIAC FUNCTION IN PULMONARY ARTERIAL HYPERTENSION: RESULTS FROM THE REPAIR ECHOCARDIOGRAPHY SUBSTUDY. Chest 2020. [DOI: 10.1016/j.chest.2020.08.1899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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28
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Chin K, Channick R, McLaughlin V, Miller C, Flynn M, Ong R, Wetherill G, Kim N. TREATMENT PATTERNS IN PULMONARY ARTERIAL HYPERTENSION: CHANGES IN CLINICAL PRACTICE OVER TIME USING REAL-WORLD EVIDENCE FROM THE COMBINED OPUS/ORPHEUS DATA SETS. Chest 2020. [DOI: 10.1016/j.chest.2020.08.1877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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29
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Torbicki A, Bacchi M, Delcroix M, Farber HW, Ghofrani HA, Hennessy B, Jansa P, Mehta S, Perchenet L, Pulido T, Rosenberg D, Rubin LJ, Sastry BKS, Simonneau G, Sitbon O, Souza R, Wei LJ, Channick R, Benza R. Integrating Data From Randomized Controlled Trials and Observational Studies to Assess Survival in Rare Diseases. Circ Cardiovasc Qual Outcomes 2020; 12:e005095. [PMID: 31109190 PMCID: PMC7665498 DOI: 10.1161/circoutcomes.118.005095] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Supplemental Digital Content is available in the text. Background: Conducting randomized controlled trials to investigate survival in a rare disease like pulmonary arterial hypertension has considerable ethical and logistical constraints. In many studies, such as the Study with an Endothelin Receptor Antagonist in Pulmonary Arterial Hypertension to Improve Clinical Outcome (SERAPHIN) randomized controlled trial, evaluating survival is further complicated by bias introduced by allowing active therapy among placebo-treated patients who clinically deteriorate. Methods and Results: SERAPHIN enrolled and followed patients in the same time frame as the US Registry to Evaluate Early And Long-term PAH Disease Management, providing an opportunity to compare observed survival for SERAPHIN patients with predicted survival had they received real-world treatment as in the Registry to Evaluate Early And Long-term PAH Disease Management. From the Registry to Evaluate Early And Long-term PAH Disease Management (N=3515), 734 patients who met SERAPHIN eligibility criteria were selected and their data used to build a prediction model for time to death up to 3 years based on 10 baseline prognostic variables. The model was used to predict a survival curve for each of the 742 SERAPHIN patients via their baseline variables. The average of these predicted survival curves was compared with observed survival of the placebo (n=250) and macitentan 10 mg (n=242) groups using a log-rank test and Cox proportional hazard model. Observed mortality risk for patients randomized to placebo, 62% of whom were taking background pulmonary arterial hypertension therapy, tended to be lower than that predicted for all SERAPHIN patients (16% lower; P=0.259). The observed placebo survival curve closely approximated the predicted survival curve for the first 15 months. Beyond that time, observed risk of mortality decreased compared with predicted mortality, potentially reflecting the impact of crossover of patients in the placebo group to active therapy. Over 3 years, risk of mortality observed with macitentan 10 mg was 35% lower than predicted mortality (P=0.010). Conclusions: These analyses show that, in a rare disease, real-world observational data can complement randomized controlled trial data to overcome some challenges associated with assessing survival in the setting of a randomized controlled trial. Clinical Trial Registration: https://www.clinicaltrials.gov. Unique identifiers: NCT00660179 and NCT00370214.
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Affiliation(s)
- Adam Torbicki
- Department of Pulmonary Circulation and Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, ECZ-Otwock, Poland (A.T.)
| | - Marisa Bacchi
- Biostatistics, Actelion Pharmaceuticals Ltd, Allschwil, Switzerland (M.B., B.H.)
| | - Marion Delcroix
- Department of Pneumology, University Hospitals Leuven, Belgium (M.D.)
| | | | - Hossein-Ardeschir Ghofrani
- University of Giessen and Marburg Lung Center, Germany, member of the German Center of Lung Research, and Department of Medicine, Imperial College London, United Kingdom (H.-A.G.)
| | - Brian Hennessy
- Biostatistics, Actelion Pharmaceuticals Ltd, Allschwil, Switzerland (M.B., B.H.)
| | - Pavel Jansa
- Clinicial Department of Cardiology and Angiology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic (P.J.)
| | - Sanjay Mehta
- Canada Respirology Division, London Health Sciences Centre, ON (S.M.)
| | - Loïc Perchenet
- Global Medical Affairs, Actelion Pharmaceuticals Ltd, Allschwil, Switzerland (L.P.)
| | - Tomas Pulido
- Cardiopulmonary Department, Ignacio Chávez National Heart Institute, Mexico City, Mexico (T.P.)
| | - Daniel Rosenberg
- Epidemiology & Observational Studies, Actelion Pharmaceuticals Ltd, Allschwil, Switzerland (D.R.)
| | - Lewis J Rubin
- Division of Pulmonary and Critical Care Medicine, University of California, San Diego Medical School (L.J.R.)
| | - B K S Sastry
- Division of Cardiology, CARE Hospitals, Hyderabad, India (B.K.S.S.)
| | - Gérald Simonneau
- APHP Centre de Référence de l'Hypertension Pulmonaire, Service de Pneumologie et Soins Intensifs, Université Paris-Sud, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France (G.S., O.S.)
| | - Olivier Sitbon
- APHP Centre de Référence de l'Hypertension Pulmonaire, Service de Pneumologie et Soins Intensifs, Université Paris-Sud, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France (G.S., O.S.)
| | - Rogério Souza
- INCOR Heart Institute, University of Sao Paulo, Brazil (R.S.)
| | - Lee-Jen Wei
- Department of Biostatistics, Harvard University, Boston, MA (L.-J.W.)
| | | | - Raymond Benza
- Division of Cardiovascular Diseases, Allegheny General Hospital, Pittsburgh, PA (R.B.)
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Noordegraaf AV, Channick R, Cottreel E, Kiely D, Martin N, Moiseeva O, Peacock A, Tawakol A, Torbicki A, Rosenkranz S, Galiè N. Results from the REPAIR Study Final Analysis: Effects of Macitentan on Right Ventricular (RV) Remodelling in Pulmonary Arterial Hypertension (PAH). J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.1140] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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31
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Chin KM, Rubin LJ, Channick R, Di Scala L, Gaine S, Galiè N, Ghofrani HA, Hoeper MM, Lang IM, McLaughlin VV, Preiss R, Simonneau G, Sitbon O, Tapson VF. Association of N-Terminal Pro Brain Natriuretic Peptide and Long-Term Outcome in Patients With Pulmonary Arterial Hypertension. Circulation 2020; 139:2440-2450. [PMID: 30982349 PMCID: PMC6530970 DOI: 10.1161/circulationaha.118.039360] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND NT-proBNP (N-terminal pro brain natriuretic peptide) levels are included in the multiparametric risk assessment approach for pulmonary arterial hypertension (PAH) outlined in PAH guidelines. However, data supporting the use of NT-proBNP risk thresholds in assessing prognosis in PAH are limited. The GRIPHON trial (Prostacyclin [PGI2] Receptor Agonist In Pulmonary Arterial Hypertension) provides an opportunity to assess the prognostic value of NT-proBNP thresholds in a controlled clinical trial and to evaluate the response to selexipag according to these thresholds. METHODS The event-driven GRIPHON trial randomly assigned patients to selexipag or placebo. NT-proBNP was measured at regular intervals in GRIPHON. Here, patients were categorized post hoc into low, medium, and high NT-proBNP subgroups according to 2 independent sets of thresholds: (1) baseline tertiles: <271 ng/L; 271 to 1165 ng/L; >1165 ng/L; and (2) 2015 European Society of Cardiology/European Respiratory Society guidelines cutoffs: <300 ng/L; 300 to 1400 ng/L; >1400 ng/L. Hazard ratios (selexipag versus placebo) with 95% CIs were calculated for the primary end point (composite morbidity/mortality events) by NT-proBNP category at baseline using Cox proportional-hazards models, and at any time during the exposure period using a time-dependent Cox model. RESULTS With both thresholds, baseline and follow-up NT-proBNP categories were highly prognostic for future morbidity/mortality events during the study ( P<0.0001). In the time-dependent analysis, the risk of experiencing a morbidity/mortality event was 92% and 83% lower in selexipag-treated patients with a low and medium NT-proBNP level, and 90% and 56% lower in placebo-treated patients with a low and medium NT-proBNP level, in comparison with patients with a high NT-proBNP level. Selexipag reduced the risk of morbidity/mortality events across all 3 NT-proBNP categories in both the baseline and time-dependent analyses, with a more pronounced treatment benefit of selexipag seen in the medium and low NT-proBNP subgroups (interaction P values 0.20 and 0.007 in the baseline and time-dependent analyses). CONCLUSIONS These analyses further establish the prognostic relevance of NT-proBNP levels in PAH and provide first evidence for the association of NT-proBNP level and treatment response. Using 2 similar sets of thresholds, these analyses support the relevance of the low, medium, and high NT-proBNP categories as part of the multiparametric risk assessment approach outlined in the European Society of Cardiology/European Respiratory Society guidelines for the management of PAH patients. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov . Unique identifier: NCT01106014.
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Affiliation(s)
- Kelly M Chin
- Division of Internal Medicine, UT Southwestern Medical Center, Dallas, TX (K.M.C.)
| | - Lewis J Rubin
- Division of Pulmonary and Critical Care Medicine, University of California, San Diego (L.J.R.)
| | - Richard Channick
- David Geffen School of Medicine, University of California Los Angeles (R.C.)
| | - Lilla Di Scala
- Actelion Pharmaceuticals Ltd, Allschwil, Switzerland (L.D.S., R.P.)
| | - Sean Gaine
- National Pulmonary Hypertension Unit, Mater Misericordiae University Hospital, Dublin, Ireland (S.G.)
| | - Nazzareno Galiè
- Department of Experimental, Diagnostic, and Specialty Medicine - DIMES, University of Bologna, Italy (N.G.)
| | - Hossein-Ardeschir Ghofrani
- University of Giessen and Marburg Lung Center, Giessen, Germany, member of the German Center of Lung Research, and Department of Medicine, Imperial College London, London, UK (H.-A.G.)
| | - Marius M Hoeper
- Department of Respiratory Medicine, Hannover Medical School and German Center of Lung Research, Hannover (M.M.H.)
| | - Irene M Lang
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Allgemeines Krankenhaus, Austria (I.M.L.)
| | - Vallerie V McLaughlin
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor (V.V.M.)
| | - Ralph Preiss
- Actelion Pharmaceuticals Ltd, Allschwil, Switzerland (L.D.S., R.P.)
| | - Gérald Simonneau
- APHP Centre de Référence de l'Hypertension Pulmonaire, Service de Pneumologie et Soins Intensifs, CHU Bicêtre, Université Paris-Sud, Le Kremlin Bicêtre, France (G.S., O.S.)
| | - Olivier Sitbon
- APHP Centre de Référence de l'Hypertension Pulmonaire, Service de Pneumologie et Soins Intensifs, CHU Bicêtre, Université Paris-Sud, Le Kremlin Bicêtre, France (G.S., O.S.)
| | - Victor F Tapson
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA (V.F.T.)
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Langleben D, Channick R, Delcroix M, Galiè N, Ghofrani A, Jansa P, Mehta S, Pulido T, Souza R, Simonneau G, Sastry B, Torbicki A, Martin N, Perchenet L, Sitbon O. SAFETY AND EFFICACY OF MACITENTAN IN ELDERLY PATIENTS WITH PULMONARY ARTERIAL HYPERTENSION (PAH): INSIGHTS FROM SERAPHIN. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)32717-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Rajagopal S, Channick R, Chin K, Kim NH, Flynn M, Leroy S, Ong R, Wetherill G, McLaughlin VV. COMORBIDITIES IN PULMONARY ARTERIAL HYPERTENSION (PAH): INSIGHTS FROM THE REAL-WORLD OPSUMIT® USERS (OPUS) REGISTRY. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)32728-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Kohli P, Kelly VJ, Kehl EG, Rodriguez-Lopez J, Hibbert KA, Kone M, Systrom DM, Waxman AB, Venegas JG, Channick R, Winkler T, Harris RS. Perfusion Imaging Distinguishes Exercise Pulmonary Arterial Hypertension at Rest. Am J Respir Crit Care Med 2020; 199:1438-1441. [PMID: 30811948 DOI: 10.1164/rccm.201810-1899le] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Puja Kohli
- 1 Massachusetts General Hospital and Harvard Medical School Boston, Massachusetts
| | | | - Ekaterina G Kehl
- 1 Massachusetts General Hospital and Harvard Medical School Boston, Massachusetts
| | | | - Kathryn A Hibbert
- 1 Massachusetts General Hospital and Harvard Medical School Boston, Massachusetts
| | - Mamary Kone
- 1 Massachusetts General Hospital and Harvard Medical School Boston, Massachusetts
| | - David M Systrom
- 3 Brigham and Women's Hospital and Harvard Medical School Boston, Massachusetts
| | - Aaron B Waxman
- 3 Brigham and Women's Hospital and Harvard Medical School Boston, Massachusetts
| | - Jose G Venegas
- 1 Massachusetts General Hospital and Harvard Medical School Boston, Massachusetts
| | - Richard Channick
- 1 Massachusetts General Hospital and Harvard Medical School Boston, Massachusetts
| | - Tilo Winkler
- 1 Massachusetts General Hospital and Harvard Medical School Boston, Massachusetts
| | - R Scott Harris
- 1 Massachusetts General Hospital and Harvard Medical School Boston, Massachusetts
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Rivera-Lebron B, McDaniel M, Ahrar K, Alrifai A, Dudzinski DM, Fanola C, Blais D, Janicke D, Melamed R, Mohrien K, Rozycki E, Ross CB, Klein AJ, Rali P, Teman NR, Yarboro L, Ichinose E, Sharma AM, Bartos JA, Elder M, Keeling B, Palevsky H, Naydenov S, Sen P, Amoroso N, Rodriguez-Lopez JM, Davis GA, Rosovsky R, Rosenfield K, Kabrhel C, Horowitz J, Giri JS, Tapson V, Channick R. Diagnosis, Treatment and Follow Up of Acute Pulmonary Embolism: Consensus Practice from the PERT Consortium. Clin Appl Thromb Hemost 2019; 25:1076029619853037. [PMID: 31185730 PMCID: PMC6714903 DOI: 10.1177/1076029619853037] [Citation(s) in RCA: 129] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Pulmonary embolism (PE) is a life-threatening condition and a leading cause of morbidity and mortality. There have been many advances in the field of PE in the last few years, requiring a careful assessment of their impact on patient care. However, variations in recommendations by different clinical guidelines, as well as lack of robust clinical trials, make clinical decisions challenging. The Pulmonary Embolism Response Team Consortium is an international association created to advance the diagnosis, treatment, and outcomes of patients with PE. In this consensus practice document, we provide a comprehensive review of the diagnosis, treatment, and follow-up of acute PE, including both clinical data and consensus opinion to provide guidance for clinicians caring for these patients.
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Affiliation(s)
| | | | - Kamran Ahrar
- 3 The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Abdulah Alrifai
- 4 University of Miami of Palm Beach Regional Campus/JFK Hospital, Atlantis, FL, USA
| | - David M Dudzinski
- 5 Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Danielle Blais
- 7 The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | | | - Roman Melamed
- 9 Abbott Northwestern Hospital, Minneapolis, MN, USA
| | | | - Elizabeth Rozycki
- 7 The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | | | | | - Parth Rali
- 10 Temple University, Philadelphia, PA, USA
| | | | | | | | | | | | - Mahir Elder
- 14 Wayne State University, Detroit, MI, USA.,15 Michigan State University, East Lansing, MI, USA
| | | | | | | | | | | | | | | | - Rachel Rosovsky
- 5 Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Kenneth Rosenfield
- 5 Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | | | - Jay S Giri
- 16 University of Pennsylvania, Philadelphia, PA, USA
| | - Victor Tapson
- 21 Cedars-Sinai Medical Center, Los Angeles, CA, USA
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McLaughlin VV, Channick R, De Marco T, Farber HW, Gaine S, Galié N, Krasuski RA, Preston I, Souza R, Coghlan JG, Frantz RP, Hemnes A, Kim NH, Lang IM, Langleben D, Li M, Sitbon O, Tapson V, Frost A. Results of an Expert Consensus Survey on the Treatment of Pulmonary Arterial Hypertension With Oral Prostacyclin Pathway Agents. Chest 2019; 157:955-965. [PMID: 31738929 DOI: 10.1016/j.chest.2019.10.043] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 10/11/2019] [Accepted: 10/28/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Treatment of pulmonary arterial hypertension (PAH) has evolved substantially over the past two decades and varies according to etiology, functional class (FC), hemodynamic parameters, and other clinical factors. Current guidelines do not provide definitive recommendations regarding the use of oral prostacyclin pathway agents (PPAs) in PAH. To provide guidance on the use of these agents, an expert panel was convened to develop consensus statements for the initiation of oral PPAs in adults with PAH. METHODS A systematic literature search was conducted using MEDLINE. The established RAND/University of California Los Angeles appropriateness method, which incorporates the Delphi method and the nominal group technique, was used to create consensus statements. Idiopathic, heritable, repaired congenital heart defect, and drug- or toxin-induced PAH (IPAH+) was considered as one etiologic grouping. The process was focused on the use of oral treprostinil or selexipag in patients with IPAH+ or connective tissue disease-associated PAH and FC II or III symptoms receiving background dual endothelin receptor antagonist/phosphodiesterase type 5 inhibitor therapy. RESULTS The panel developed 14 consensus statements regarding the appropriate use of oral PPAs in the target population. The panel identified 13 clinical scenarios in which selexipag may be considered as a treatment option. CONCLUSIONS The paucity of clinical evidence overall, and particularly from randomized trials in this setting, creates a gap in knowledge. These consensus statements are intended to aid physicians in navigating treatment options and using oral PPAs in the most appropriate manner in patients with PAH.
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Affiliation(s)
| | - Richard Channick
- Department of Medicine, University of California Los Angeles Medical Center, Los Angeles, CA
| | - Teresa De Marco
- Department of Cardiology, University of California, San Francisco, CA
| | - Harrison W Farber
- Division of Pulmonary, Critical Care and Sleep Medicine, Tufts Medical Center, Boston, MA
| | | | - Nazzareno Galié
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Bologna, Italy
| | | | - Ioana Preston
- Division of Pulmonary, Critical Care and Sleep Medicine, Tufts Medical Center, Boston, MA
| | - Rogerio Souza
- Pulmonary Department, Heart Institute, University of São Paulo Medical School, São Paulo, Brazil
| | - J Gerry Coghlan
- Department of Cardiology, Royal Free Hospital, London, England
| | - Robert P Frantz
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Anna Hemnes
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Nick H Kim
- Department of Cardiothoracic Surgery, University of California San Diego Medical Center, San Diego, CA
| | - Irene M Lang
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Allgemeines Krankenhaus, Vienna, Austria
| | - David Langleben
- Center for Pulmonary Vascular Disease, Cardiology Division, Jewish General Hospital and McGill University, Montreal, QC, Canada
| | - Mengtao Li
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Olivier Sitbon
- Université Paris-Saclay, APHP, Hôpital Bicêtre, Service de Pneumologie, Le Kremlin-Bicêtre, France
| | - Victor Tapson
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Adaani Frost
- Department of Medicine, Institute of Academic Medicine, Houston Methodist Hospital, Houston, TX
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Langleben D, Gaine S, Sitbon O, Channick R, Chin K, Di Scala L, Galiè N, Hoeper M, McLaughlin V, Preiss R, Rubin L, Simonneau G, Tapson V, Ghofrani H, Lang I. THE IMPACT OF TIME FROM DIAGNOSIS AT BASELINE ON LONG-TERM OUTCOME IN THE GRIPHON STUDY: SELEXIPAG IN PULMONARY ARTERIAL HYPERTENSION (PAH). Can J Cardiol 2019. [DOI: 10.1016/j.cjca.2019.07.180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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McLaughlin V, Channick R, Chin K, Leary P, Miller C, Brand M, Flynn M, Leroy S, Morganti A, Kim N. P3674Patient characteristics and treatment patterns in the multicentre, retrospective chart review of first-time Opsumit (macitentan) users in the United States (OrPHeUS). Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
The OPsumit® Historical USers cohort (OrPHeUS) is a multicentre, US, retrospective medical chart review conducted to supplement the OPsumit® USers (OPUS) Registry to fulfil the FDA request to characterise the safety of macitentan in clinical practice.
Purpose
To describe patient characteristics, treatment patterns, hepatic safety and survival in patients with pulmonary hypertension (PH) newly treated with macitentan.
Methods
OrPHeUS (NCT03197688) aimed to include 2200 new users of macitentan, between October 2013 and March 2017, who were not enrolled in OPUS. Here we present patients with follow-up data, including characteristics and treatment patterns at macitentan initiation, hepatic adverse events (HAEs) identified using preferred terms in chart entries and pharmacovigilance reporting, hospitalisations and survival.
Results
OrPHeUS included 2982 patients newly treated with macitentan and with follow-up data; the reason for macitentan prescription was pulmonary arterial hypertension (PAH) in 2362 (79.3%) patients, other PH aetiologies in 612 (20.6%) patients and 8 patients with other/unknown reasons. At macitentan initiation, the median (Q1, Q3) age of the patients was 62 (51, 72) years and 73.9% were female. WHO functional class (FC) was documented in 654 (21.9%) patients, 35.6% of patients were in FC I/II and 64.4% in FC III/IV; median (Q1, Q3) 6-minute walk distance, documented in 411 (13.8%) patients, was 293 (200, 383) metres. At macitentan initiation, 41.5% (n=1239) of patients were not receiving PAH therapy, 46.3% (n=1382) were already receiving one PAH therapy and 11.9% (n=356) were already receiving two PAH therapies. The median (Q1, Q3) exposure to macitentan was 14.9 (5.6, 27.1) months; 57% and 43% of patients had exposures of >12 and >18 months. During the exposure period, 933 (31.3%) patients discontinued treatment, including 474 (15.9%) patients who discontinued due to an adverse event (AE), 6 (0.2%) due to a HAE, 449 (15.1%) for reasons other than an AE/HAE, and 4 (0.1%) for unknown reasons. There were 275 (9.2%) patients who experienced ≥1 HAE (incidence rate [IR]: 0.07 [95% CI, 0.06, 0.08] per 1 person-year); alanine aminotransferase (ALT) or aspartate aminotransferase (AST) ≥3x upper limit of normal (ULN) were experienced by 113 (3.8%) patients (IR: 0.028 [95% CI, 0.023, 0.033] per 1 person-year); ALT/AST ≥x3 ULN and bilirubin ≥2x ULN was experienced by 33 (1.1%) patients (IR: 0.008 [95% CI, 0.006, 0.011] per 1 person-year). There were 1148 (38.5%) patients who experienced at least one hospitalisation (IR: 0.36 [95% CI, 0.34, 0.39] per 1 person-year). The 12-month Kaplan-Meier survival estimate was 92% (95% CI, 91, 93).
Conclusion
OrPHeUS provides additional real-world evidence in patients newly treated with macitentan, confirming the hepatic safety profile of macitentan.
Acknowledgement/Funding
Actelion Pharmaceuticals Ltd
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Affiliation(s)
- V McLaughlin
- University of Michigan, Ann Arbor, United States of America
| | - R Channick
- University of California Los Angeles, Los Angeles, United States of America
| | - K Chin
- University of Texas Southwestern Medical School, Dallas, United States of America
| | - P Leary
- University of Washington, Seattle, United States of America
| | - C Miller
- Piedmont Healthcare, Atlanta, United States of America
| | - M Brand
- Actelion Pharmaceuticals Ltd, Allschwil, Switzerland
| | - M Flynn
- Actelion Pharmaceuticals US, Inc, South San Francisco, United States of America
| | - S Leroy
- Actelion Pharmaceuticals Ltd, Allschwil, Switzerland
| | - A Morganti
- Actelion Pharmaceuticals Ltd, Allschwil, Switzerland
| | - N Kim
- University of California San Diego, La Jolla, United States of America
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Channick R, Chin K, Kim N, McConnell J, Poch D, Flynn M, Leber L, Morganti A, McLaughlin V. P4673Macitentan in chronic thromboembolic pulmonary hypertension (CTEPH): combined data from OPUS and OrPHeUS real-world data sets. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.1055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
The OPsumit® USers Registry (OPUS) provides real-world data in patients (pts) with pulmonary hypertension newly started on macitentan. The OPsumit® Historical USers cohort (OrPHeUS) study was conducted to supplement OPUS to fulfil the FDA request to characterise the safety of macitentan in clinical practice. Both studies included pts with CTEPH.
Purpose
To describe the characteristics and safety outcomes of CTEPH pts newly treated with macitentan.
Methods
OPUS is a prospective, US, multicentre, long-term, observational drug registry (NCT02126943) ongoing since Apr 2014. OrPHeUS was a retrospective, US, multicentre medical chart review (NCT03197688); data collected Oct 2013-Mar 2017. This subgroup analysis describes CTEPH patient characteristics at macitentan initiation, hospitalisations, survival and liver function tests (LFTs) in the combined OPUS/OrPHeUS data set. LFTs are also provided for the OPUS/OrPHeUS pulmonary arterial hypertension (PAH) population.
Results
As of Oct 2018, OPUS/OrPHeUS included 144 CTEPH pts with follow-up data. At macitentan initiation, median (Q1, Q3) age was 66 (56, 73) years; of the 53 pts with a WHO functional class (FC) assessment, 35.8%, 49.1% and 15.1% were in FC II, III and IV, respectively. Median (Q1, Q3) time from CTEPH diagnosis was 18.6 (7.4, 56.4) months (n=141). At macitentan initiation, 32.6% of pts had no PAH therapy, 63.9% were receiving one and 3.5% were receiving two PAH therapies. Median (Q1, Q3) exposure to macitentan was 15.9 (4.3, 30.4) months. There were 43 (29.9%) CTEPH pts who discontinued treatment; 23 due to an adverse event (AE), 0 due to a hepatic AE (HAE) and 20 not due to an AE/HAE. There were 58 (40.3%) CTEPH pts who experienced ≥1 hospitalisation and 9 (6.3%) pts died. LFTs are presented in the table.
LFTs CTEPH follow-up pts PAH follow-up pts (N=144) (N=4072) ALT or AST ≥3x ULN Pts with ≥1 event, n (%) 1 (0.7) 132 (3.2) Incidence rate per 1 person-year (95% CI) 0.005 (0.001, 0.035) 0.024 (0.020, 0.029) ALT or AST ≥3x ULN and total bilirubin ≥2x ULN Pts with ≥1 event, n (%) 1 (0.7) 27 (0.7) Incidence rate per 1 person-year (95% CI) 0.005 (0.001, 0.035) 0.005 (0.003, 0.007) ALT: alanine aminotransferase; AST: aspartate aminotransferase; CI: confidence interval; ULN: upper limit of normal.
Conclusions
Analysis of OPUS/OrPHeUS data provides further insight into real-world use of macitentan in CTEPH pts. The observed hepatic safety profile in CTEPH pts is in line with that of PAH pts.
Acknowledgement/Funding
Actelion Pharmaceuticals Ltd
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Affiliation(s)
- R Channick
- University of California Los Angeles, Los Angeles, United States of America
| | - K Chin
- University of Texas Southwestern Medical School, Dallas, United States of America
| | - N Kim
- University of California San Diego, La Jolla, United States of America
| | - J McConnell
- Kentuckiana Pulmonary Associates, Louisville, United States of America
| | - D Poch
- University of California San Diego, La Jolla, United States of America
| | - M Flynn
- Actelion Pharmaceuticals US, Inc., South San Francisco, United States of America
| | - L Leber
- Actelion Pharmaceuticals Ltd, Allschwil, Switzerland
| | - A Morganti
- Actelion Pharmaceuticals Ltd, Allschwil, Switzerland
| | - V McLaughlin
- University of Michigan, Ann Arbor, United States of America
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Chin K, Kim N, McLaughlin V, Frantz R, Rodriguez-Lopez J, Brand M, Flynn M, Leroy S, Morganti A, Channick R. MACITENTAN IN THE ELDERLY POPULATION WITH PULMONARY ARTERIAL HYPERTENSION: REAL-WORLD EVIDENCE FROM THE COMBINED OPUS REGISTRY AND ORPHEUS COHORT. Chest 2019. [DOI: 10.1016/j.chest.2019.08.376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Shaikh F, Anklesaria Z, Shagroni T, Saggar R, Gargani L, Bossone E, Ryan M, Channick R, Saggar R. A review of exercise pulmonary hypertension in systemic sclerosis. J Scleroderma Relat Disord 2019; 4:225-237. [PMID: 35382504 DOI: 10.1177/2397198319851653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 04/06/2019] [Indexed: 11/16/2022]
Abstract
In general, pulmonary vascular disease has important negative prognostic implications, regardless of the associated condition or underlying mechanism. In this regard, systemic sclerosis is of particular interest as it is the most common connective tissue disease associated with pulmonary hypertension, and a well-recognized at-risk population. In the setting of systemic sclerosis and unexplained dyspnea, the concept of using exercise to probe for underlying pulmonary vascular disease has acquired significant interest. In theory, a diagnosis of systemic sclerosis-associated exercise pulmonary hypertension may allow for earlier therapeutic intervention and a favorable alteration in the natural history of the pulmonary vascular disease. In the context of underlying systemic sclerosis, the purpose of this article is to provide a comprehensive review of the evolving definition of exercise pulmonary hypertension, the current role and methodologies for non-invasive and invasive exercise testing, and the importance of the right ventricle.
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Affiliation(s)
- Faisal Shaikh
- University of California-Los Angeles, Los Angeles, CA, USA
| | | | | | - Rajeev Saggar
- Banner University Medical Center Phoenix, Phoenix, AZ, USA
| | - Luna Gargani
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | | | - Michael Ryan
- Central Coast Chest Consultants, San Luis Obispo, CA, USA
| | | | - Rajan Saggar
- University of California-Los Angeles, Los Angeles, CA, USA
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McLaughlin V, Channick R, Kim N, Lammi M, Sulica R, Brand M, Flynn M, Leroy S, Morganti A, Chin K. MACITENTAN IN PULMONARY ARTERIAL HYPERTENSION ASSOCIATED WITH CONNECTIVE TISSUE DISEASE: REAL-WORLD EVIDENCE FROM THE COMBINED OPUS/ORPHEUS DATA SETS. Chest 2019. [DOI: 10.1016/j.chest.2019.08.827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Rosenkranz S, Channick R, Chin K, Jenner B, Gaine S, Galie N, Ghofrani HA, Hoeper MM, McLaughlin VV, Preiss R, Rubin LJ, Simonneau G, Sitbon O, Tapson V, Lang IM. 4973Efficacy and safety of selexipag in pulmonary arterial hypertension (PAH) patients with and without significant cardiovascular (CV) comorbidities. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Many PAH patients today have a number of CV comorbidities, yet data on the efficacy and safety of therapies in such patients remain scarce. Most recent PAH clinical trials also include patients with comorbidities.
Purpose
To assess the long-term efficacy and safety of the oral, selective IP prostacyclin receptor agonist, selexipag, in PAH patients with and without significant CV comorbidities using post hoc analysis of GRIPHON data.
Methods
GRIPHON enrolled 1156 PAH patients randomised 1:1 to placebo:selexipag. The present analysis includes patients with right heart catheterisation within 1 year of randomisation who were categorised as with or without CV comorbidities. Patients with CV comorbidities were defined as having ≥3 of the following: body mass index (BMI) >30 kg/m2, history of essential hypertension, diabetes mellitus, or historical evidence of significant coronary artery disease; if PAWP/LVEDP was >12 but <15 mmHg, pulmonary vascular resistance (PVR) had to be >500 dyn.sec/cm5; if PAWP/LVEDP was <12, then PVR had to be >300 dyn.sec/cm5. Selexipag effect on time to first morbidity/mortality (M/M) event up to end of treatment was assessed for both subgroups. Baseline (BL) adjusted treatment hazard ratios with 95% CIs were calculated using Cox models. Model building involved stepwise backward elimination of BL covariates.
Results
752 PAH patients could be categorised based on these criteria (99 with CV comorbidities, 653 without). At BL, patients with CV comorbidities were older (median [range] 60 [28–80] vs 46 [18–78] yrs), had higher BMI (mean [SD] 33.3 [7.23] vs 26.0 [5.64] kg/m2) and lower 6-minute walk distance (mean [SD] 319 [95.7] vs 354 [79.3] m) vs those without. A greater proportion were from Western Europe/Australia/North America (60.6% vs 38.9%) and in WHO functional class III (69.7% vs 49.9%). At BL, 82.8% of patients with CV comorbidities were receiving PAH therapies vs 75.7% of those without. As expected, at BL a higher proportion of patients with CV comorbidities (vs without) had previous/concomitant cardiac disease (62.6% vs 43.0%), metabolism/nutrition disorders (75.8% vs 31.2%), respiratory/thoracic/mediastinal disorders (59.6% vs 37.5%) and vascular disorders (76.8% vs 37.4%). Selexipag reduced the risk of M/M events vs placebo in both subgroups (Figure), with no evidence of an inconsistent treatment effect (interaction p-value=0.1544). Adverse events leading to treatment discontinuation were reported in 35.4% (25.9% selexipag, 46.7% placebo) of patients with CV comorbidities and 35.0% (32.0% selexipag, 38.0% placebo) of those without. Common prostacyclin associated side effects observed with selexipag (headache, diarrhoea, nausea) were reported at a similar incidence in both subgroups.
Conclusions
Selexipag had a beneficial effect on long-term outcome in PAH patients both with and without CV comorbidities. Safety in both groups was consistent with the known profile of selexipag.
Acknowledgement/Funding
Actelion Pharmaceuticals Ltd
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Affiliation(s)
| | - R Channick
- University of California Los Angeles, Los Angeles, United States of America
| | - K Chin
- UT Southwestern Medical Centre, Dallas, United States of America
| | - B Jenner
- Actelion Pharmaceuticals Ltd, Allschwil, Switzerland
| | - S Gaine
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - N Galie
- University of Bologna, Department of Experimental, Diagnostic and Specialty Medicine - DIMES, Bologna, Italy
| | - H A Ghofrani
- University of Giessen and Marburg Lung Center, Giessen, Germany, member of the German Center for Lung Research, and Department of Medicine, Imperial College London, London, United Kingdom
| | - M M Hoeper
- Department of Respiratory Medicine, Hannover Medical School and German Center for Lung Research, Hannover, Germany
| | - V V McLaughlin
- University of Michigan, Ann Arbor, United States of America
| | - R Preiss
- Actelion Pharmaceuticals Ltd, Allschwil, Switzerland
| | - L J Rubin
- Division of Pulmonary and Critical Care Medicine, University of California, San Diego, United States of America
| | - G Simonneau
- Hopital Universitaire de Bicetre, Universite Paris-Sud, Le Kremlin Bicetre, France
| | - O Sitbon
- Hopital Universitaire de Bicetre, Universite Paris-Sud, Le Kremlin Bicetre, France
| | - V Tapson
- Cedars-Sinai Medical Center, Los Angeles, United States of America
| | - I M Lang
- Division of Cardiology, Medical University of Vienna, Vienna, Austria
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Chandy G, Channick R. The Identification and Management of Unsuspected Hemodynamically Unstable Pulmonary Embolism: The Need for Structured Multidisciplinary Teams. Can J Cardiol 2019; 35:819-820. [PMID: 31292079 DOI: 10.1016/j.cjca.2019.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 04/29/2019] [Accepted: 04/29/2019] [Indexed: 10/26/2022] Open
Affiliation(s)
- George Chandy
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
| | - Richard Channick
- Division of Pulmonary, Critical Care, Sleep Medicine, Clinical Immunology and Allergy, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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Channick R, Chin K, Kim N, Brand M, Morganti A, Selej M, McLaughlin V. Patient Characteristics and Treatment Patterns with Macitentan in Pulmonary Arterial Hypertension: Insights from the OPUS Registry. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.1245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Channick R, McLaughlin V, Chin K, McConnell J, Poch D, Brand M, Selej M, Morganti A, Kim N. Treatment of Chronic Thromboembolic Pulmonary Hypertension (CTEPH): Real-World Experience with Macitentan. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.1229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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47
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Seki A, Anklesaria Z, Saggar R, Dodson MW, Schwab K, Liu MC, Charan Ashana D, Miller WD, Vangala S, DerHovanessian A, Channick R, Shaikh F, Belperio JA, Weigt SS, Lynch JP, Ross DJ, Sullivan L, Khanna D, Shapiro SS, Sager J, Gargani L, Stanziola A, Bossone E, Schraufnagel DE, Fishbein G, Xu H, Fishbein MC, Wallace WD, Saggar R. Capillary Proliferation in Systemic-Sclerosis-Related Pulmonary Fibrosis: Association with Pulmonary Hypertension. ACR Open Rheumatol 2019; 1:26-36. [PMID: 31777777 PMCID: PMC6858021 DOI: 10.1002/acr2.1003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Objective We sought to determine if any histopathologic component of the pulmonary microcirculation can distinguish systemic sclerosis (SSc)‐related pulmonary fibrosis (PF) with and without pulmonary hypertension (PH). Methods Two pulmonary pathologists blindly evaluated 360 histologic slides from lungs of 31 SSc‐PF explants or autopsies with (n = 22) and without (n = 9) PH. The presence of abnormal small arteries, veins, and capillaries (pulmonary microcirculation) was semiquantitatively assessed in areas of preserved lung architecture. Capillary proliferation (CP) within the alveolar walls was measured by its distribution, extent (CP % involvement), and maximum number of layers (maximum CP). These measures were then evaluated to determine the strength of their association with right heart catheterization–proven PH. Results Using consensus measures, all measures of CP were significantly associated with PH. Maximum CP had the strongest association with PH (P = 0.013; C statistic 0.869). Maximum CP 2 or more layers and CP % involvement 10% or greater were the optimal thresholds that predicted PH, both with a sensitivity of 56% and specificity of 91%. The CP was typically multifocal rather than focal or diffuse and was associated with a background pattern of usual interstitial pneumonia. There was a significant but weaker relationship between the presence of abnormal small arteries and veins and PH. Conclusion In the setting of advanced SSc‐PF, the histopathologic feature of the pulmonary microcirculation best associated with PH was capillary proliferation in architecturally preserved lung areas.
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Affiliation(s)
| | | | - Rajeev Saggar
- Banner University Medical Center University of Arizona Phoenix
| | - Mark W Dodson
- Intermountain Medical Center, Murray, Utah and University of Utah School of Medicine Salt Lake City
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Dinesh Khanna
- University of Michigan Scleroderma Program Ann Arbor
| | | | - Jeffrey Sager
- Santa Barbara Pulmonary Associates Santa Barbara California
| | - Luna Gargani
- Institution of Clinical Physiology National Research Council Pisa Italy
| | | | | | | | | | - Haodong Xu
- University of Washington School of Medicine Seattle
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48
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Kratzert WB, Boyd EK, Saggar R, Channick R. Critical Care of Patients After Pulmonary Thromboendarterectomy. J Cardiothorac Vasc Anesth 2019; 33:3110-3126. [PMID: 30948200 DOI: 10.1053/j.jvca.2019.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 02/19/2019] [Accepted: 03/01/2019] [Indexed: 12/16/2022]
Abstract
Pulmonary thromboendarterectomy (PTE) remains the only curative surgery for patients with chronic thromboembolic pulmonary hypertension (CTEPH). Postoperative intensive care unit care challenges providers with unique disease physiology, operative sequelae, and the potential for detrimental complications. Central concerns in patients with CTEPH immediately after PTE relate to neurologic, pulmonary, hemodynamic, and hematologic aspects. Institutional experience in critical care for the CTEPH population, a multidisciplinary team approach, patient risk assessment, and integration of current concepts in critical care determine outcomes after PTE surgery. In this review, the authors will focus on specific aspects unique to this population, with integration of current available evidence and future directions. The goal of this review is to provide the cardiac anesthesiologist and intensivist with a comprehensive understanding of postoperative physiology, potential complications, and contemporary intensive care unit management immediately after pulmonary endarterectomy.
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Affiliation(s)
- Wolf B Kratzert
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA.
| | - Eva K Boyd
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Rajan Saggar
- Department of Internal Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Richard Channick
- Department of Internal Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
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Witkin A, Wilcox SR, Chang Y, Huang F, Dudzinski D, Zheng H, Channick R, Kabrhel C. Impact of chronic right ventricular pressure overload in short-term outcomes of acute pulmonary embolism: A retrospective analysis. J Crit Care 2019; 51:1-5. [PMID: 30673622 DOI: 10.1016/j.jcrc.2019.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 01/08/2019] [Accepted: 01/10/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE Evaluate the association between chronic right ventricle (RV) dysfunction by transthoracic echocardiogram (TTE) and outcomes in patients with acute pulmonary embolism (PE). METHODS This was a retrospective analysis of TTE findings in acute PEs. TTEs were used to classify the presence of chronic right ventricular pressure overload (RPVO), defined as RV hypertrophy or RV systolic pressure (RVSP) >50 mmHg, acute RVPO, defined as RV dysfunction not meeting the chronic RVPO definition, or no RV dysfunction. The primary outcome was a composite of death or need for advanced PE therapies at 7 days. RESULTS Of 466 patients, 288 had evidence of RV dysfunction. Thirty percent (140) had evidence of chronic RVPO and 148 patients had evidence of acute RVPO. Chronic RVPO patients were older (P = .004), more likely to have COPD, and had lower heart rates and troponin-t values. The acute RVPO patients included more women and were less likely to have a prior PE. There was no difference in outcomes between the acute and chronic RVPO cohorts. CONCLUSIONS Chronic RVPO patients had lower heart rates and troponin-t values. Despite these differences there were no differences in need for advanced therapeutic interventions or 7 day mortality.
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Affiliation(s)
- Alison Witkin
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, United States.
| | - Susan R Wilcox
- Department of Emergency Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, United States.
| | - Yuchiao Chang
- Department of Emergency Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, United States.
| | - Fei Huang
- Department of Emergency Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, United States.
| | - David Dudzinski
- Division of Cardiology, Department of Medicine Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, United States.
| | - Hui Zheng
- Department of Emergency Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, United States.
| | - Richard Channick
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, United States.
| | - Christopher Kabrhel
- Department of Emergency Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, United States.
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50
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Dalia AA, Streckenbach S, Andrawes M, Channick R, Wright C, Fitzsimons M. Management of Pulmonary Hemorrhage Complicating Pulmonary Thromboendarterectomy. Front Med (Lausanne) 2018; 5:326. [PMID: 30525040 PMCID: PMC6258717 DOI: 10.3389/fmed.2018.00326] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 11/05/2018] [Indexed: 11/21/2022] Open
Abstract
Airway management during pulmonary thromboendarterectomy (PTE) can prove challenging, especially in the face of unexpected intraoperative pulmonary hemorrhage. Utilization of proper airway equipment on induction is crucial for the successful management of intraoperative pulmonary hemorrhage. Our case series describes the preoperative risk factors that can lead to intraoperative pulmonary hemorrhage, the preinduction airway equipment considerations for PTE, and the intraoperative management of pulmonary hemorrhage. We summarize the lessons learned at our institution from four cases of post perfusion pulmonary hemorrhage.
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Affiliation(s)
- Adam A Dalia
- Department of Anesthesiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Scott Streckenbach
- Department of Anesthesiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Mike Andrawes
- Department of Anesthesiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Richard Channick
- Department of Anesthesiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Cameron Wright
- Department of Anesthesiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Michael Fitzsimons
- Department of Anesthesiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
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