Key result
Selexipag was associated with a 46% lower risk of all-cause hospitalization (HR 0.54) compared to oral treprostinil in patients with pulmonary hypertension.
Why the study?
Two oral prostacyclin pathway medications are available for pulmonary arterial hypertension in the United States, but real-world comparative hospitalization data were needed.
Does selexipag reduce hospitalization compared to oral treprostinil in adults with pulmonary hypertension?
Cohort (n=222)
Does selexipag reduce hospitalization compared to oral treprostinil in adults with pulmonary hypertension?
Hazard Ratio: 0.54 (95% CI 0.31–0.92)
Absolute Event Rate: 26% vs 47.5%
p-value: p=0.02
In a real-world US claims database, selexipag was associated with significantly lower risks and rates of all-cause and pulmonary hypertension-related hospitalizations compared to oral treprostinil.
May support selexipag over oral treprostinil to lower PH hospitalizations; hypothesis-generating and requires randomized confirmation.
Two oral medications targeting the prostacyclin pathway are available to treat pulmonary arterial hypertension in the United States: oral treprostinil and selexipag. We compared real‐world hospitalization in patients receiving these medications. A retrospective administrative claims study was conducted using the Optum® Clinformatics® Data Mart database. Patients with pulmonary hypertension were identified using diagnostic codes. Cohort inclusion required age ≥ 18 years, first oral treprostinil or selexipag prescription between 1 January 2015 and 30 September 2017 (index date), and continuous enrollment in the prior ≥6 months. Patients who switched index drug were excluded. Follow‐up was from index date until the first of end of index drug exposure, end of continuous enrollment, death, or 31 December 2017. Multivariable Cox proportional hazard and Poisson regression were used to compare risk and rate, respectively, of hospitalization associated with oral treprostinil vs. selexipag, adjusting for potential confounders. The study cohort included 99 patients receiving oral treprostinil and 123 receiving selexipag. Mean age was 61 years, and most patients were females (71%). Compared with oral treprostinil, selexipag was associated with a 46% lower risk of all‐cause hospitalization (hazard ratio 0.54, 95% confidence interval 0.31, 0.92; P = 0.02), a 47% lower risk of pulmonary hypertension‐related hospitalization (hazard ratio 0.53, 95% confidence interval 0.31, 0.93; P = 0.03), a 42% lower all‐cause hospitalization rate (rate ratio 0.58, 95% confidence interval 0.39, 0.87; P = 0.01), and a 46% lower pulmonary hypertension‐related hospitalization rate (rate ratio 0.54, 95% confidence interval 0.35, 0.82; P = 0.004). This study suggests that selexipag is associated with lower hospitalization risk and rate than oral treprostinil.
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McConnell et al. (2020) conducted a cohort in pulmonary hypertension (n=222). Selexipag vs. Oral treprostinil was evaluated on Risk of all-cause hospitalization (HR 0.54, 95% CI 0.31, 0.92, p=0.02). Selexipag was associated with a 46% lower risk of all-cause hospitalization (HR 0.54) compared to oral treprostinil in patients with pulmonary hypertension.
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