In treatment-naïve patients with inoperable CTEPH, selexipag monotherapy reduced mean pulmonary arterial pressure by 5.4 mmHg, which did not differ significantly from the reduction with riociguat.
Observational (n=30)
No
Does selexipag monotherapy improve pulmonary hemodynamics in treatment-naïve patients with inoperable CTEPH prior to balloon pulmonary angioplasty compared to riociguat?
Selexipag monotherapy significantly reduces mean pulmonary arterial pressure and pulmonary vascular resistance in treatment-naïve patients with inoperable CTEPH prior to balloon pulmonary angioplasty, though riociguat provides greater improvement in cardiac output.
Absolute Event Rate: -5.4% vs -7.8%
Background Selexipag has been approved for the treatment of chronic thromboembolic pulmonary hypertension (CTEPH) in Japan since April 2021; however, its hemodynamic effects in treatment-naïve patients with inoperable CTEPH prior to balloon pulmonary angioplasty (BPA) remain unclear. This study evaluated the impact of selexipag monotherapy on pulmonary hemodynamics before first BPA. Methods Between August 2021 and February 2024, 40 newly diagnosed, treatment-naïve patients with inoperable CTEPH undergoing their initial BPA session were screened at Yokohama City University Hospital. After excluding three patients in the riociguat group due to insufficient titration time, 30 patients (15 selexipag, 15 riociguat) were included in this retrospective observational study. Hemodynamic parameters were assessed before and after pharmacotherapy and compared within and between groups. Results The selexipag group included 10 women (mean age 66.5 years; average dose 2.2 mg/day). Selexipag significantly reduced mean pulmonary arterial pressure (mPAP) from 39.0 to 33.6 mmHg (−5.4 ± 6.7 mmHg; P = 0.008) and pulmonary vascular resistance (PVR) from 8.07 to 6.69 Wood units (WU; −1.38 ± 1.2 WU; P = 0.001), without a significant change in cardiac output (CO). Riociguat significantly reduced mPAP (−7.8 ± 8.5 mmHg; P = 0.003) and PVR (−2.57 ± 2.4 WU; P = 0.001) and increased CO (+0.81 ± 1.0 L/min; P = 0.006). Changes in mPAP and PVR did not differ significantly between groups, whereas CO increased significantly more with riociguat ( P = 0.04). Conclusions In this exploratory, hypothesis-generating retrospective study, selexipag monotherapy was associated with reductions in mPAP and PVR in treatment-naïve patients with inoperable CTEPH before BPA, whereas riociguat showed greater CO improvement. These findings warrant prospective validation in selected patients before broader clinical application.
Komura et al. (Mon,) conducted a observational in Chronic thromboembolic pulmonary hypertension (CTEPH) (n=30). Selexipag vs. Riociguat was evaluated on Change in mean pulmonary arterial pressure (mPAP). In treatment-naïve patients with inoperable CTEPH, selexipag monotherapy reduced mean pulmonary arterial pressure by 5.4 mmHg, which did not differ significantly from the reduction with riociguat.