Key result
Selexipag cuts PAH-related complications or death by ~40% versus placebo.
Why the study?
Does selexipag exposure correlate with clinical response parameters and pharmacokinetics in patients with pulmonary arterial hypertension?
RCT (n=1,156)
Double-blind
Randomized
Yes
Does selexipag exposure correlate with clinical response parameters and pharmacokinetics in patients with pulmonary arterial hypertension?
Population PK/PD modeling demonstrates that selexipag exposure correlates with improvements in exercise capacity and NT-proBNP without clinically relevant effects on vital signs, supporting the strategy of individual dose up-titration in PAH.
Answers are grounded in this paper and cite their sources.
Selexipag dosing should follow clinical response without exposure or comedication adjustments; extends GRIPHON data with PK/PD modeling but leaves practice unchanged.
Selexipag (Uptravi) is an oral selective IP prostacyclin receptor agonist approved for the treatment of pulmonary arterial hypertension (PAH). The pivotal GRIPHON study was the largest clinical study ever conducted in PAH patients, providing long-term data from 1,156 patients. PAH comedication did not affect exposure to selexipag, while exposure to its active metabolite ACT-333679 was reduced by 30% when taken in combination, clinically not relevant in the context of individual dose up-titration. Using log-linear regression models linking model-predicted steady-state exposure to pharmacodynamics (PD), exposure to selexipag and ACT-333679 showed some statistically significant, albeit not clinically relevant, effects on exercise capacity, laboratory values, and the occurrence of prostacyclin-related adverse events, but not on vital signs or adverse events denoting hemorrhage. Using suitable modeling techniques, the GRIPHON study yielded clinically relevant data with limited burden of pharmacokinetics (PK) blood sampling, demonstrating that PK/PD modeling enables firm conclusions even with sparse PK and PD sampling.
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Krause et al. (2017) conducted an RCT in Pulmonary arterial hypertension (n=1,156). Selexipag vs. Placebo was evaluated on Time to death (from any cause) or a complication related to PAH (HR 0.6, 95% CI 0.46-0.78, p=<0.001). Selexipag reduced the risk of death or a complication associated with underlying pulmonary arterial hypertension by 40% compared to placebo.
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