Key result
Selexipag reduces the morbidity and mortality composite endpoint in patients with pulmonary arterial hypertension, though its role in initial triple oral therapy lacks clear benefit.
Why the study?
Current guidelines do not provide definitive recommendations regarding the place of selexipag in the treatment algorithm of pulmonary arterial hypertension.
Does selexipag improve clinical outcomes in adult patients with symptomatic pulmonary arterial hypertension?
Does selexipag improve clinical outcomes in adult patients with symptomatic pulmonary arterial hypertension?
Selexipag is an effective oral prostacyclin receptor agonist that reduces morbidity and mortality in PAH, though its role in initial triple therapy and exact place in treatment algorithms remain under evaluation.
May support selexipag addition in PAH with inadequate response; leaves open optimal placement in algorithms pending further trials.
INTRODUCTION: Selexipag is a first-in-class, oral, long-acting, selective, non-prostanoid agonist of the prostacyclin receptor (IP receptor), indicated for the treatment of symptomatic adult pulmonary arterial hypertension (PAH). It was designed with the objective to surpass the inconveniences associated with standard prostanoid therapy, presenting fewer adverse effects and comparable hemodynamic benefits. AREAS COVERED: This review describes the pharmacologic properties of selexipag and presents the clinical trials that have been completed or are currently ongoing regarding its clinical efficacy, safety, and tolerability. The pivotal GRIPHON study is extensively presented. EXPERT OPINION: Selexipag is the first IP receptor to reduce the morbidity/mortality composite endpoint of the GRIPHON study, a large, randomized, placebo-controlled study. The TRITON study failed to demonstrate a clear benefit of initial triple oral therapy including selexipag compared to initial double oral therapy. Current guidelines do not provide definitive recommendations regarding the place of selexipag in the treatment algorithm of PAH. Finally, the possibility of transition between the several drugs acting in the prostacyclin pathway, and the potential role of selexipag in chronic thromboembolic pulmonary hypertension and pediatric PAH is currently being examined, possibly expanding its future use.
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Panagiotidou et al. (2020) conducted a review in symptomatic adult pulmonary arterial hypertension (PAH). Selexipag was evaluated. Selexipag reduces the morbidity and mortality composite endpoint in patients with pulmonary arterial hypertension, though its role in initial triple oral therapy lacks clear benefit.
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