Predicting the Need for Upfront Combination Therapy in Pulmonary Arterial Hypertension

Abstract

Patients with PAH who require combination therapy in the course of their disease have worse hemodynamics, PAH risk score, functional class, and end of 6MWT oxygen saturation at the time of presentation compared to patients maintained on monotherapy.

Medical Therapies for the Treatment of Pulmonary Arterial Hypertension: How Do We Choose?

“…The results of the RCT AMBITION, assessing upfront Tadalafil and Ambristenan, are awaited, but initial data appear promising. Attempts have been made to identify those likely to benefit from this strategy retrospectively; Bajwa et al suggests patients displaying more severe haemodynamics at diagnosis with higher PAH risk score, poorer FC and low oxygen saturation on exercise may be an appropriate cohort; however, this needs prospectively verified and objectified on a larger scale [73]. Upfront combination therapy is likely to have a role in the future for severe PAH and possibly for young fitter patients in whom a more aggressive treatment stance may be taken.…”