Key result
Switching to macitentan is linked to improved functional class in PAH, with ~92% continuing therapy.
Why the study?
It was unclear whether switching patients with suboptimally controlled pulmonary arterial hypertension from bosentan or ambrisentan to macitentan improves functional outcomes.
Does switching to or adding macitentan improve 6MWT distance and functional class in patients with suboptimally controlled pulmonary arterial hypertension?
Cohort (n=37)
No
Does switching to or adding macitentan improve 6MWT distance and functional class in patients with suboptimally controlled pulmonary arterial hypertension?
Switching to macitentan in patients with suboptimally controlled pulmonary arterial hypertension on older endothelin receptor antagonists is well tolerated and may improve functional class.
Switching to macitentan may improve functional capacity in suboptimally controlled PAH; hypothesis-generating and requires randomized confirmation before practice change.
OBJECTIVES: To assess whether switching patients with suboptimally controlled pulmonary arterial hypertension from bosentan or ambrisentan to macitentan would improve six-minute walk test (6MWT) distance and World Health Organization functional class. METHODS: This was a retrospective cohort analysis of 37 patients from a single center. Patients were separated into three heterogeneous treatment groups and followed for 18 months: switch group (n = 14): patients switched to macitentan from bosentan/ambrisentan; added group (n = 11): patients who began macitentan as de novo therapy (n = 5) or who added macitentan to an existing sildenafil regimen (n = 6); and control group (n = 12): patients for whom sildenafil and/or bosentan/ambrisentan therapy was unchanged. RESULTS: Mortality was observed in two patients (one each, switch and added groups). Patients in the control group had one hospital admission and 100% survival. There was significant improvement in functional class for the switch and added groups. Statistically significant improvement was observed in 6MWT distance in the added group alone. Overall, 92% of patients continued macitentan throughout the study. CONCLUSION: Macitentan was well tolerated. For bosentan/ambrisentan-treated patients with suboptimally controlled pulmonary arterial hypertension, switching to macitentan may facilitate an improvement in functional class.
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Tynan et al. (2019) conducted a cohort in Pulmonary arterial hypertension (n=37). Macitentan vs. Unchanged sildenafil and/or bosentan/ambrisentan therapy was evaluated on Six-minute walk test (6MWT) distance and World Health Organization functional class. Switching to macitentan significantly improved functional class in patients with pulmonary arterial hypertension, with 92% of patients continuing the drug throughout the 18-month study.
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