A real-world comparative effectiveness analysis of macitentan versus ambrisentan and bosentan on hospitalizations and healthcare resource utilization in patients with pulmonary arterial hypertension

BACKGROUND: Few studies have evaluated macitentan alongside other endothelin receptor antagonists (ERAs) in patients with pulmonary arterial hypertension (PAH). This retrospective, observational, real-world, comparative effectiveness analysis assessed outcomes in PAH with macitentan versus other ERAs. METHODS: Adults (≥18 years) were included from the de-identified Optum Clinformatics Data Mart database (January 2014-December 2023). Index date was first ERA prescription. Patients were continuously enrolled in the database for ≥12 months before index (baseline), with pulmonary hypertension/PAH diagnosis and right-heart catheterization during baseline. Primary endpoint was time to first PAH-related hospitalization (Cox proportional-hazards). Secondary endpoints included healthcare resource utilization. RESULTS: Overall, 518 patients receiving macitentan and 379 other ERAs (ambrisentan, n = 370; bosentan, n = 9) were included. Mean age was 67 years and ∼70 % were female. Patients on macitentan versus other ERAs had higher baseline Charlson Comorbidity Index (P < 0.007). Risks of PAH-related and all-cause hospitalization were 19 % and 20 % lower, respectively, for macitentan versus other ERAs (hazard ratios: 0.81, P = 0.034; 0.80, P = 0.020, respectively). There were fewer all-cause and PAH-related intensive care unit (ICU) stays for macitentan versus other ERAs (P = 0.009, P = 0.013, respectively). Overall duration of all-cause ICU stay per patient per year was significantly shorter for macitentan versus other ERAs (7.0 vs 7.7 days; P = 0.003), as was the duration of all-cause ICU stay per visit (2.4 vs 3.7 days; P = 0.003). CONCLUSION: Macitentan was associated with a significantly reduced risk of PAH-related and all-cause hospitalization, with lower ICU healthcare resource utilization, versus other ERAs.