Initial triple combination therapy with selexipag increased the proportion of patients achieving three low-risk criteria versus sequential therapy (69.2% vs. 33.3%) and reduced disease progression.
Cohort (n=153)
No
Does initial triple combination therapy with selexipag improve risk stratification and reduce disease progression compared to early sequential therapy in Chinese patients with pulmonary arterial hypertension?
In Chinese patients with PAH, initial triple combination therapy with selexipag significantly improved exercise capacity, right heart structure, and risk stratification, and was associated with a lower risk of disease progression compared to sequential add-on therapy.
Absolute Event Rate: 69.2% vs 33.3%
p-value: p=0.0001
Aim Selexipag has demonstrated safety and efficacy in the treatment of pulmonary arterial hypertension (PAH). However, the strategy of triple therapy involving selexipag and its impact on right heart remodeling requires further clarification in Chinese patients with PAH. Methods and results This investigation was conducted as a single-center, retrospective study. Patients with PAH who presented to Qilu Hospital of Shandong University from February 2022 to November 2023 with a definitive diagnosis of Group 1 PAH and who received a triple targeted therapy based on selexipag were included for a safety and efficacy evaluation. Data for the French pulmonary hypertension network non-invasive risk assessment, echocardiogram parameters, and clinical data were collected. Comparisons between initial and early sequential triple combination were conducted. A total of 153 patients were entered into the safety analysis and 146 patients were included in the efficacy analysis. No unknown side effects were reported. After selexipag treatment for 29 weeks in median, 96 (65.8%) reached WHO FC II compared to 39 (26.7%) at baseline ( p 0.001). The 6MWD increased from 414 ± 108 m to 480 (420, 506) m ( p 0.001), the NT-proBNP level decreased from 928 (307, 1,923) pg/mL to 455 (134, 1,678) pg/mL ( p 0.001). The number of patients that had 3, 2, 1 or 0 low-risk criteria at baseline were 18 (12.3%), 26 (17.8%), 32 (21.9%), and 70 patients (47.9%), respectively. The risk stratification of patients improved significantly during follow-up, with the number of patients meeting 3 low-risk criteria increasing to 74 (50.7%). There was significant improvement in right atrial area, right ventricle diameter, and tricuspid annular plane systolic excursion. The average follow-up period was 33 ± 10 months. The hazard ratio for the risk of experiencing a first disease progression event was 0.177 ( p = 0.036, 95% CI: 0.035–0.898) for initial triple combination therapy, compared to early sequential selexipag add-on therapy. Conclusion Triple-targeted drug therapy containing selexipag can be safely and effectively used in Chinese PAH patients, significantly enhancing exercise capacity, improving right heart structure and function, and optimizing risk stratification. Selexipag-based initial triple therapy may offer demonstrable benefits for long term prognosis.
Cui et al. (Thu,) conducted a cohort in Pulmonary arterial hypertension (n=153). Initial triple combination therapy with selexipag vs. Sequential selexipag add-on therapy was evaluated on Improvement to 3 low-risk criteria on the French noninvasive risk assessment (p=0.0001). Initial triple combination therapy with selexipag increased the proportion of patients achieving three low-risk criteria versus sequential therapy (69.2% vs. 33.3%) and reduced disease progression.