A Team‐Based Patient Engagement Approach to Selexipag Initiation and Maintenance in Pulmonary Arterial Hypertension (TEAM PAH): Real‐World Dosing Patterns and Persistence Among Patients With and Without a History of Methamphetamine Use

Selexipag is an oral prostacyclin receptor agonist approved for pulmonary arterial hypertension (PAH). This single‐center, retrospective study described oral selexipag dosing patterns and persistence, overall and stratified by history of methamphetamine (meth) use, at an expert center in California, USA, using a multidisciplinary, nurse‐directed protocol entailing frequent follow‐up and individualized side effect management. Medical charts of patients with PAH initiating oral selexipag between January 2016 and March 2023 were abstracted. Patient characteristics and dosing patterns were described up to 14 months post‐initiation. The individualized maintenance dose (IMD) was the first dose maintained for ≥ 14 days after reaching the maximum tolerated dose. Persistence was described using Kaplan–Meier analysis. A total of 200 patients initiated oral selexipag (median age 52 years; 69.5% female; 54.5% White; 70.5% on triple therapy; 41% with a history of meth use). Most patients (89.0%) achieved maintenance (median IMD: 900 μg twice daily; median time to maintenance: 2.5 months). Selexipag persistence at 1 year was 76.2%, with most discontinuations occurring within 2 months of initiation. Similar proportions of patients with and without a history of meth use achieved maintenance (85.4% vs. 91.5%; p = 0.3) and persisted on selexipag at 1 year (74.0% vs. 77.5%; p = 0.9). Using a multidisciplinary nurse‐directed protocol, most patients with PAH were titrated to their IMD and persisted on oral selexipag, including those with a history of meth use. These findings highlight the importance of frequent patient contact for dose adjustment and side effect management, particularly earlier in the titration process.