Time Is of the Essence in PAH Therapy

Naranjo, Mario; Hassoun, Paul M.

doi:10.1016/j.chest.2021.02.009

Cited by 2 publications

(1 citation statement)

References 11 publications

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“…Prior evidence suggests that there may be greater clinical benefits to combination therapy in patients initiated earlier compared to those initiated later [ 42 , 43 ]. Thus, providing patients with prompt access to all available PAH treatment classes is key to improving long-term outcomes and potentially mitigating any downstream costs associated with disease progression [ 36 , 44 ].…”

Section: Discussionmentioning

confidence: 99%

Real-World Treatment Patterns Among Patients with Connective Tissue Disorder-Related Pulmonary Arterial Hypertension in the United States: A Retrospective Claims-Based Analysis

Sargent,

Tsang,

Panjabi

et al. 2023

Adv Ther

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Introduction Connective tissue disorders (CTDs) are the most frequent diseases associated with pulmonary arterial hypertension (PAH). Despite advances in treatment, the prognosis of CTD-related PAH remains poor. To help identify areas for improvement in the management of CTD-related PAH, this study assessed real-world PAH treatment patterns in this population in the US. Methods Eligible adult patients with PAH initiated on a PAH treatment (index date: 1st initiation date) were identified from Optum’s de-identified Clinformatics ® Data Mart Database (10/01/2015–09/30/2021) and categorized into mutually exclusive cohorts (CTD + PAH; PAH) based on the presence of CTD diagnosis claims. Treatment patterns were assessed from the index date to the earliest of death or end of continuous insurance eligibility, or data availability. Treatment persistence was assessed using Kaplan-Meier analysis. Results A total of 4751 patients were included (CTD + PAH: n = 728, mean follow-up of 18.8 months; PAH: n = 4023, mean follow-up of 19.6 months). For both cohorts, the most common first treatment regimens were sildenafil (CTD + PAH: 38.7%; PAH: 51.5%), tadalafil (10.0%; 9.4%), and macitentan (8.1%; 5.4%) monotherapy; these were also the most frequent agents included in any of the first 3 treatment regimens. Combination therapy was more frequent in the CTD + PAH versus PAH cohort (any regimen: 40.9% vs. 27.2%; 1st treatment regimen: 26.9% vs. 18.5%; 2nd: 52.8% vs. 42.0%; 3rd: 55.2% vs. 48.5%). Treatment persistence was similar across cohorts and the first three treatment regimens, with persistence rates ranging from 42.6 to 49.7% at 12 months. Conclusions Treatment patterns were generally similar between the CTD + PAH and PAH cohorts, although combination therapy was more frequent in the CTD + PAH cohort. Both cohorts may benefit from broader use of all available PAH treatment classes, including combination therapy. Considering the life-threatening nature of PAH, our findings also highlight the need to address the low persistence rates with PAH therapies regardless of etiology.

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Section: Discussionmentioning

confidence: 99%

Real-World Treatment Patterns Among Patients with Connective Tissue Disorder-Related Pulmonary Arterial Hypertension in the United States: A Retrospective Claims-Based Analysis

Sargent,

Tsang,

Panjabi

et al. 2023

Adv Ther

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Congruency between clinician‐assessed risk and calculated risk of 1‐year mortality in patients with pulmonary arterial hypertension: A retrospective chart review

Raina,

Sketch,

et al. 2024

Pulm. circ.

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The objective of this analysis was to compare clinician‐based and formally calculated risk assessments by REVEAL Lite 2 and COMPERA 2.0 and to characterize parenteral prostacyclin utilization within 90 days of baseline in high‐risk patients. A multisite, double‐blind, retrospective chart review of patients with pulmonary arterial hypertension (PAH) was conducted with an index period of January 2014–March 2017. Patients were categorized into the “any PAH medication” or “prostacyclin‐enriched” cohort based on latest PAH medication initiated within the index period. Clinicians classified the patient's 1‐year mortality risk as “low,” “intermediate,” or “high” based on their clinical assessment. REVEAL Lite 2 and COMPERA 2.0 scores were independently calculated. Risk assessment congruency was evaluated. Parenteral prostacyclin use was evaluated within 90 days of baseline. Thirty‐two clinicians participated and abstracted data for 299 patients with PAH. At baseline, mean patient age was 52 years, 6‐min walk distance was 226 m, and most patients were WHO functional class II or III. Half of the patients (53%) were classified by clinician assessment as intermediate risk, while most were classified as high risk by REVEAL Lite 2 (59%) and intermediate‐high risk by COMPERA 2.0 (52%). Parenteral prostascyclins were underutilized in high‐risk patients, and not initiated in a timely fashion. Clinician‐assessed risk category was incongruent with tool‐based risk assessments in 40%–54% of patients with PAH, suggesting an underestimation of the patient's risk category by clinician gestalt. Additionally, there was a lack of timely prostacyclin initiation for patients with PAH stratified as high‐risk by either tool.

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Time Is of the Essence in PAH Therapy

Cited by 2 publications

References 11 publications

Real-World Treatment Patterns Among Patients with Connective Tissue Disorder-Related Pulmonary Arterial Hypertension in the United States: A Retrospective Claims-Based Analysis

Real-World Treatment Patterns Among Patients with Connective Tissue Disorder-Related Pulmonary Arterial Hypertension in the United States: A Retrospective Claims-Based Analysis

Congruency between clinician‐assessed risk and calculated risk of 1‐year mortality in patients with pulmonary arterial hypertension: A retrospective chart review

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