Key result
Riociguat combination regimens may improve clinical outcomes in pulmonary arterial hypertension not meeting goals.
Why the study?
Effective clinical decision-making for initial treatment and therapy escalation in PAH depends on multiple factors including patient risk profile, with emerging data on riociguat combination regimens.
Does riociguat combination therapy or switching from a PDE5i improve outcomes in patients with pulmonary arterial hypertension?
Does riociguat combination therapy or switching from a PDE5i improve outcomes in patients with pulmonary arterial hypertension?
Riociguat may be beneficial as part of upfront combination therapy with an endothelin receptor antagonist or as a switch from a PDE5i in patients with PAH not meeting treatment goals.
Effective clinical decision-making in initial treatment selection and switching or escalations of therapy for pulmonary arterial hypertension (PAH) depends on multiple factors including the patient's risk profile. Data from clinical trials suggest that switching from a phosphodiesterase-5 inhibitor (PDE5i) to the soluble guanylate cyclase stimulator riociguat may provide clinical benefit in patients not reaching treatment goals. In this review, we cover the clinical evidence for riociguat combination regimens for patients with PAH and discuss their evolving role in upfront combination therapy and switching from a PDE5i as an alternative to escalating therapy. Specifically, we review current evidence which suggests or provides a hypothesis for 1) the potential use of riociguat plus endothelin receptor antagonist combinations for upfront combination therapy in patients with PAH at intermediate to high risk of 1-year mortality and 2) the benefits of switching to riociguat from a PDE5i in patients who are not achieving treatment goals with PDE5i-based dual combination therapy and at intermediate risk.
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Rahaghi et al. (2023) conducted a review in pulmonary arterial hypertension. riociguat vs. PDE5i was evaluated. Riociguat combination therapies may provide clinical benefit as upfront therapy or when switching from a PDE5i in patients with pulmonary arterial hypertension not reaching treatment goals.
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