Initial dual oral combination therapy in pulmonary arterial hypertension
Treatment for pulmonary arterial hypertension (PAH) has been underpinned by single agent therapy to which concomitant drugs are added sequentially when pre defined treatment goals are not met. This retrospective analysis of real world clinical data in 97 patients with newly diagnosed PAH (86% in New York Heart Association functional class III IV) explored initial dual oral combination treatment with bosentan plus sildenafil (n=61) bosentan plus tadalafil (n=17) ambrisentan plus tadalafil (n=11) or ambrisentan plus sildenafil (n=8) All regimens were associated with significant improvements in functional class, exercise capacity, dyspnoea and haemodynamic indices after 4 months of therapy. Over a median follow up period of 30 months, 75 (82% patients were still alive, 53 (71% of whom received only dual oral combination therapy. Overall survival rates were 97% 94% and 83% at 1, 2 and 3 years, respectively, and 96% 94% and 84% respectively, for the patients with idiopathic PAH, heritable PAH and anorexigen induced PAH. Expected survival rates calculated from the French equation for the latter were 86% 75% and 66% at 1, 2 and 3 years, respectively. Initial combination of oral PAH targeted medications may offer clinical benefits, especially in PAH patients with severe haemodynamic impairment. Initial dual combination therapy may offer potential benefits in PAH patients with severe haemodynamic impairment http:/ow.ly/YNxgk
European Respiratory Journal