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. 2016 Jun;47(6):1727-36.
doi: 10.1183/13993003.02043-2015. Epub 2016 Mar 17.

Initial dual oral combination therapy in pulmonary arterial hypertension

Olivier Sitbon  1 , Caroline Sattler  2 , Laurent Bertoletti  3 , Laurent Savale  2 , Vincent Cottin  4 , Xavier Jaïs  2 , Pascal De Groote  5 , Ari Chaouat  6 , Céline Chabannes  7 , Emmanuel Bergot  8 , Hélène Bouvaist  9 , Claire Dauphin  10 , Arnaud Bourdin  11 , Fabrice Bauer  12 , David Montani  2 , Marc Humbert  2 , Gérald Simonneau  2
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Free article

Initial dual oral combination therapy in pulmonary arterial hypertension

Olivier Sitbon et al. Eur Respir J. 2016 Jun.
Free article

Abstract

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.

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