Novel Approach to Evaluate the Role of Selexipag in Pulmonary Arterial Hypertension

Abstract

Parenteral prostanoids remain the cornerstone of therapy for advanced pulmonary arterial hypertension (PAH). 1 The oral prostanoid receptor selexipag held promise to provide the clinical benefits of this class while avoiding the need for an infusion. Two randomized clinical trials form the basis of guideline recommendations on the use of selexipag in PAH. 1 The GRIPHON trial 2 randomized 1156 patients to selexipag or placebo irrespective of nonprostanoid background therapy and demonstrated a 40% reduction in morbidity and mortality events over a mean of 14 months and a slight increase in walk distance. In contrast, selexipag did not provide therapeutic value when used as part of an up-front triple therapy in conjunction with an endothelin receptor antagonist (ERA) and a phosphodiesterase type 5 inhibitor (PDE5) inhibitor in the TRITON trial. 3 In 2023, a post hoc pooled analysis of patients with incident PAH (within 6 months of diagnosis) who participated in the initial GRIPHON and TRITON trials was completed. 4 In 329 patients who received selexipag, there was a reduction in the risk of disease progression (hazard ratio, 0.48; 95% CI, 0.3-0.56) compared with 320 patients in the control group.