Transition initiation of oral treprostinil was associated with significantly higher 1-year persistence compared to de novo initiation (OR 2.48; 95% CI 1.42-4.33; p=0.0014).
Cohort (n=394)
Does persistence to oral treprostinil in patients with pulmonary arterial hypertension vary by initiation year or by initiation strategy (de novo vs. transition)?
Real-world persistence to oral treprostinil has improved over the past decade, with patients transitioning to the therapy demonstrating significantly higher persistence than de novo initiators.
Effect estimate: OR 2.48 (95% CI 1.42-4.33)
p-value: p=0.0014
Abstract Rationale Oral treprostinil was approved in 2013 for the treatment of pulmonary arterial hypertension (PAH), but limited persistence data exist. We aimed to understand oral treprostinil persistence changes over time. Methods A retrospective cohort study of patients initiating oral treprostinil was conducted using Optum’s de-identified Clinformatics® Data Mart Database (1/01/14-9/30/24). Patients were indexed on date of first oral treprostinil claim. Patients were ≥18 years of age at index and had ≥1 inpatient or ≥ 2 outpatient medical claims separated by ≥ 30 days with a pulmonary hypertension diagnosis, continuous insurance enrollment, and no oral treprostinil claims in 6-months pre-index. Patients were grouped into treatment initiation years (2014-16, 2017-21, and 2022-24) and stratified by initiation type (de novo: 3 mg or transition: ≥3 mg total daily dose). Oral treprostinil persistence (no gap in therapy ≥60 days) was quantified in the 3-, 6-, and 12-months post-index. Predictors of 12-month persistence were measured with logistic regression. Time to non-persistence was evaluated with Kaplan-Meier and Cox Proportional Hazard methods. Results 394 patients were included (2014-16: 81 21%, 2017-21: 208 53%, 2022-24: 105 27%). At baseline, patient demographics were similar between groups, except for age, gender, and Quan-CCI score. The proportion of patients transitioning increased over time (28.4%, 30.3%, 52.4% in 2014-16, 2017-21, and 2022-24, respectively; p 0.001). Overall, persistence was 83%, 72%, and 57% at 3- 6- and 12-months post-index; no differences were observed between time periods. Median persistence time was higher in the 2017-21 group compared to the 2014-16 group (543 IQR 394-746 days vs. 350 IQR 226-502 days, p = 0.04); however, no differences in persistent time were found between 2017-21 vs. 2022-24 and 2014-16 vs. 2022-24. In adjusted Cox models, patients initiating in 2017-21 had lower discontinuation risk compared to those initiating in 2014-16 (hazard ratio HR; 95% CI = 0.64 0.45-0.9; p = 0.01). When stratified by initiation type, transition patients had higher median persistence time compared to de novo (654 455-1248 days vs. 403 278-537 days; p 0.005). In adjusted logistic model, transition initiation was associated with 1-year persistence (Odds Ratio 95% confidence interval = 2.48 1.42-4.33; p = 0.0014). Adjusted cox model demonstrated transition initiation was associated with lower discontinuation hazard (HR 95% CI: 0.67 0.48-0.95; p = 0.02). Conclusions Transition to oral treprostinil is increasingly being utilized over the past decade with higher persistence compared to de novo initiators. Oral treprostinil persistence time improved, potentially due to better adverse effect management and provider knowledge. Sponsored by United Therapeutics This abstract is funded by: United Therapeutics Corporation
Lachant et al. (Fri,) conducted a cohort in Pulmonary arterial hypertension (n=394). Oral treprostinil (transition initiation) vs. De novo initiation (<3 mg total daily dose) was evaluated on 1-year persistence (OR 2.48, 95% CI 1.42-4.33, p=0.0014). Transition initiation of oral treprostinil was associated with significantly higher 1-year persistence compared to de novo initiation (OR 2.48; 95% CI 1.42-4.33; p=0.0014).
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