Choice of Initial Oral Therapy for Pulmonary Arterial Hypertension: Age and Long-Term Survival
Abstract
Oral therapy is recommended for patients with lowor intermediate-risk pulmonary arterial hypertension (PAH) (1). Up-front combination therapy is currently favored on the basis of the AMBITION (Ambrisentan and Tadalafil in Patients with Pulmonary Arterial Hypertension) trial showing delayed PAH hospitalizations at the cost of increased side effects (2). However, comparative long-term survival outcome data are lacking, and the specific drug choice remains controversial. Thus, we aimed to determine which initial oral treatment is associated with better long-term survival. We also sought to ascertain baseline patient characteristics that might help predict response to one particular class of therapy. We conducted a retrospective cohort study in patients with group 1 PAH initially treated with either an endothelin receptor antagonist (ERA) or a phosphodiesterase 5 inhibitor (PDE5i). We excluded patients in whom a second agent was added within 8 weeks. The primary outcome was all-cause mortality. Forty-three baseline variables considered as confounders (covariates) included demographics, comorbidities, vital signs, functional status, pulmonary function testing, echocardiographic data, right heart hemodynamics, and laboratory studies. For variables with missing data, we performed a single imputation using a random draw from the existing values, and we created a missingness indicator for the variables with at least 20 missing values. We adjusted for imbalances in these covariates by…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 237 participants or records.
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