Sequential combination therapy with bosentan and sildenafil in patients failing monotherapy improved haemodynamics and yielded 1-, 3-, and 5-year overall survival estimates of 91%, 69%, and 59%.
Observational
Does sequential combination therapy with bosentan and sildenafil improve clinical parameters, haemodynamics, and survival in patients with pulmonary arterial hypertension failing monotherapy?
Sequential combination therapy with bosentan and sildenafil improves short-term hemodynamics and provides good long-term survival in PAH patients failing monotherapy.
Pulmonary arterial hypertension is a severe disease with a complex pathogenesis, for which combination therapy is an attractive option.This study aimed to assess the impact of sequential combination therapy on both short-term responses and long-term outcomes in a real-world setting.Patients with idiopathic/heritable pulmonary arterial hypertension, or pulmonary arterial hypertension associated with congenital heart disease or connective tissue disease and who were not meeting treatment goals on either first-line bosentan or sildenafil monotherapy, were given additional sildenafil or bosentan and assessed after 3-4 months. Double combination therapy significantly improved clinical and haemodynamic parameters, independent of aetiology or the order of drug administration. Significant improvements in functional class were observed in patients with idiopathic/heritable pulmonary arterial hypertension. The 1-, 3- and 5-year overall survival estimates were 91%, 69% and 59%, respectively. Patients with pulmonary arterial hypertension associated with connective tissue disease had significantly poorer survival rates compared to other aetiologies (p<0.003).The favourable short-term haemodynamic results and good survival rates, observed in patients receiving both bosentan and sildenafil, supports the use of sequential combination therapy in patients failing on monotherapy in a real-world setting.
Dardi et al. (Thu,) conducted a observational in Pulmonary arterial hypertension. Sequential combination therapy (bosentan and sildenafil) was evaluated on Short-term clinical and haemodynamic responses and long-term overall survival. Sequential combination therapy with bosentan and sildenafil in patients failing monotherapy improved haemodynamics and yielded 1-, 3-, and 5-year overall survival estimates of 91%, 69%, and 59%.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: