P6341Haemodynamic and exercise effects of different types of initial oral combination therapy in pulmonary arterial hypertension

Rinaldi, Andrea; Dardi, Fabio; Albini, Alessandra; Gotti, Enrico; Monti, Enrico; Palazzini, Massimiliano; Zuffa, Elisa; Guarino, Daniele; Pasca, F; Lorenzis, Alessandro De; Orzalkiewicz, Mateusz; Manes, Alessandra; Galiè, Nazzareno

doi:10.1093/eurheartj/ehy566.p6341

Cited by 4 publications

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“…The search strategy resulted in 681 identified studies after duplicates were removed. Subsequently, 59 full-text articles were assessed for eligibility and, eventually, we considered 13 studies eligible [5][6][7][8][9][10][11][12][13][14][15][16][17]. The study selection process and the corresponding flow chart is presented in Supplemental Material 2.…”

Section: Resultsmentioning

confidence: 99%

Haemodynamic effects of initial combination therapy in pulmonary arterial hypertension: a systematic review and meta-analysis

Farmakis

Vrana²,

Mouratoglou³

et al. 2022

ERJ Open Res

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BackgroundAlthough the initial use of combination treatment has been proved beneficial for patients’ clinical outcome, there is scarce data on its hemodynamic effects.ObjectiveTo evaluate the effect of an initial combination of PAH-targeted therapies on hemodynamic parameters in treatment-naïve PAH patients.MethodsA systematic search of PubMed, CENTRAL and Web of Science was performed. We considered eligible studies with an intervention of initial PAH-targeted combination therapy in treatment-naïve PAH patients with or without monotherapy control. A random effects meta-analysis was performed for the difference between baseline and follow-up in pulmonary vascular resistance (PVR) and other hemodynamic parameters.ResultsOf 880 patients receiving initial combination therapy PVR was reduced by −6.5 WU (95%CI −7.4; −5.7) or by −52% (95%CI −56%; −48%, I2=0%) compared to baseline. Initial triple therapy including a parenteral prostanoid resulted in significantly greater PVR reduction (−67% versus −50% with all other combination therapies, p=0.01). The effect was more pronounced in younger patients (p=0.02). Compared to baseline, there was −12.2 mmHg (95%CI −14.0; −10.4) decrease in mean pulmonary artery pressure, 0.9 l min·m−2 (95%CI 0.8; 1.1) increase in cardiac index, −3.2 mmHg (95%CI, −4.1; −2.3) decrease in right atrial pressure and 8.6% (95%CI 6.9; 10.3) increase in mixed venous oxygen saturation. In the controlled studies, initial combination therapy reduced PVR by −4.2 WU (95%CI −6.1; −2.4) compared to monotherapy.ConclusionInitial combination therapy leads to remarkable hemodynamic amelioration. Parenteral prostanoids should be considered early, especially in more severely affected patients, to enable RV reverse remodeling.

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Section: Resultsmentioning

confidence: 99%

Haemodynamic effects of initial combination therapy in pulmonary arterial hypertension: a systematic review and meta-analysis

Farmakis

Vrana²,

Mouratoglou³

et al. 2022

ERJ Open Res

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“…Продолжая освещение темы комбинации АЭР и силденафила, стоит упомянуть исследование А. Rinaldi и соавт., в котором проводили ретроспективное сравнение групп пациентов с ЛАГ, получавших комбинированную терапию бозентаном с силденафилом и мацитентаном с силденафилом, а также монотерапию данными лекарственными препаратами. Эффективность комбинированной схемы лечения достоверно превзошла монотерапию, однако значимых различий между комбинациями с различными АЭР не выявлено [42].…”

Section: обзор доказательной базы посвященной оценке эффективности и ...unclassified

Combination therapy of newly diagnosed intermediate-risk pulmonary arterial hypertension: A review

2022

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Advancements in the specific therapy of pulmonary arterial hypertension (PAH) and new combination therapy strategies and escalation treatment over the past decade have significantly improved disease control, slowed its progression, and improved quality of life and patient survival. This review provides a detailed discussion of current strategies for PAH-specific therapy available in the Russian Federation for patients with classical and non-classical PAH who fail to achieve treatment goals and remain at intermediate risk of disease progression/mortality.

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“…Очевидно, что сочетание бозентана и силденафила не может рассматриваться как опция для начальной комбинированной ЛАГ-специфической терапии. Несмотря на наличие такого опыта [22,23], исследования СOMPASS-2 и NCT00323297 убедительно показали неэффективность последовательной комбинации этих препаратов, вероятно, вследствие опосредованного цитохромом Р450 лекарственного взаимодействия со снижением концентрации силденафила [24][25][26].…”

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“…В посвященном начальной ЛАГ-специфической терапии ретроспективном исследовании A. Rinaldi и соавт., 2018 [23] 28 пациентов получали стартовую комбинацию мацитентана и силденафила. Последняя эффективнее улучшала гемодинамику (среднее ДЛА, ЛСС и сердечный индекс), чем монотерапия АРЭ или иФДЭ-5.…”

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Advantages and limitations of initial combination therapy in pulmonary arterial hypertension patients in Russia

Шмальц

Горбачевский

2020

Terapevticheskii arkhiv

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Pulmonary arterial hypertension (PAH) is severe and often times rapidly progressive disease with fatal outcome. The concept of initial combination of PAH-specific therapies in high risk patients at baseline was first described in the European guidelines on pulmonary hypertension (PH) in 2009, and in low or intermediate risk patients at baseline in 2015. Interestingly, that in Cologne Experts Consensus, and then in the 6th World Symposium on PH medical community started considering initial combination therapy as one of the most important pillars in PAH treatment algorithms in 2018. As of August 2020, as many as 8 formulations of 7 reference PAH-specific drugs are licensed for medical use in the Russian Federation. On top of that, 6 abbreviated drugs (generics) have also become available few years ago. Unfortunately, intravenous and subcutaneous prostacyclin analogs (PCA) and tadalafil are not approved for PH patients treatment in the Russian Federation. In this narrative review paper we attempted to describe studies on initial dual combination therapy with PAH-specific drugs registered in Russia, i.e. ambrisentan and riociguat, macitentan and riociguat, macitentan and sildenafil in low or intermediate risk patients at baseline, as well as iloprost inhaled and sildenafil, iloprost inhaled and bosentan in high risk patients. Some beneficial pharmacological effects due to the synergy between ambrisentan plus riociguat, and inhaled iloprost plus sildenafil appear to be interesting and require further clinical confirmation. Other initial combinations of PAH-specific agents require large-scale clinical trials as well.

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P6341Haemodynamic and exercise effects of different types of initial oral combination therapy in pulmonary arterial hypertension

Cited by 4 publications

References 0 publications

Haemodynamic effects of initial combination therapy in pulmonary arterial hypertension: a systematic review and meta-analysis

Haemodynamic effects of initial combination therapy in pulmonary arterial hypertension: a systematic review and meta-analysis

Combination therapy of newly diagnosed intermediate-risk pulmonary arterial hypertension: A review

Advantages and limitations of initial combination therapy in pulmonary arterial hypertension patients in Russia

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