Triple therapy for incident pulmonary arterial hypertension in Finland between 2008 and 2020. A descriptive real-world FINPAH cohort study
Abstract
Treatment of pulmonary arterial hypertension (PAH) with triple therapy (TriT) including phosphodiesterase type-5 inhibitors (PDE5), endothelin receptor antagonists (ERA), and prostacyclin receptor agonists (PRA) or analogues (PCA) is indicated in severe PAH. There is evidence of benefit also in intermediate-risk patients.
To describe the real-world use of TriT in a contemporary cohort of Finnish PAH patients.
Data was collected via chart review by treating clinicians. Pulmonary hypertension (PH) patients were diagnosed between 2008–19 at the five Finnish university hospitals. Patient characteristics and clinical information were combined with mortality data from Statistics Finland. Persistence and survival were estimated using Kaplan-Meier.
Out of 493 incident PH patients with medication history available, TriT was recorded for 41 (8%), with a median follow-up of 5.86 years (IQR: 4.12-8.72). TriT patients were predominantly women (73%), mean age 55 years (IQR 46–69) at diagnosis. 35 patients (85%) had PAH (37% iPAH, 27% PAH associated with connective tissue disease and 22% other PAH subclasses), and 6 patients (15%) had other PH types, mostly CTEPH. TriT was started at a median of 2.15 years (IQR: 0.65-3.64) after diagnosis. At the initiation of TriT, 7 patients (17%) had NYHA functional class (FC) IV, 21 (51%) had FC III, 8 (20%) had FC II. Median six-minute walking distance (6MWD) was 360 m (IQR 245-435 m, N=33). Median BNP was 328 pg/mL (IQR 190-723, N=10), and median…
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