Retrospective Database Analysis of Treatment Patterns Among Patients with Pulmonary Arterial Hypertension

Abstract

Introduction: Release of the 2015 European Society of Cardiology (ESC)/European Respiratory Society (ERS) guidelines put increased emphasis on using combination therapy, either as upfront or sequential therapy among patients with pulmonary arterial hypertension (PAH). However, with these recommendations and the therapy advances made in the last several years, little is known on the real-world treatment patterns among patients with PAH, particularly before and after publication of the 2015 ESC/ERS guidelines. Methods: This was a retrospective study of adult commercial and Medicare Advantage with Part D (MAPD) enrollees with at least one claim for a PAH-related medication from January 01, 2012 to March 31, 2017, at least one medical claim with a pulmonary hypertension diagnosis, and continuous health plan enrollment at least 6 months prior to and at least 12 months following the date of the first pharmacy claim for PAH-related therapy (index date). Patients were divided into cohorts based on prescription of monotherapy or combination therapy and index date category (

Real-World Analysis of Treatment Patterns Among Hospitalized Patients with Pulmonary Arterial Hypertension

“…In addition, the results add to evidence suggesting a slow but steady shift toward greater use of combination therapy that generally coincides with the introduction of pivotal clinical guidelines in 2015 (ESC/ERS pulmonary hypertension guidelines). Specifically, real-world data show that the proportions of patients with PAH prescribed combination therapy increased from 5% before the release of the abovementioned guidelines to ~ 20% observed in the present study (with most patients [72.2%] observed after 2015) [ 22 , 28 ].…”

“…Nonetheless, while combination therapy appears to be gaining traction, the data still appear to speak to a persisting lag between evidence favoring greater and earlier use of combination therapy in general [ 9 , 10 , 28 – 32 ]. In this context, the low levels of treatment escalation we observed after hospitalization suggest that many clinicians are not making a full connection between hospitalization, clinical worsening, and the need for treatment intensification.…”

Real‐world treatment patterns, healthcare resource utilization, and cost among adults with pulmonary arterial hypertension in the United States

“…The first line of treatment was determined by the number of different medication classes observed within the first 30 days after the index date, a definition used in prior administrative claims studies. 7 , 22 , 23 Those with only one medication class within the first 30 days were defined as initiating monotherapy, whereas those with two or more medication classes within the first 30 days post‐index were considered to initiate combination therapy. Oral prostacyclin/IP receptor agonists, inhaled prostacyclin, and parenteral prostacyclin were distinguished as three medication classes.…”

“… 21 The FDA approval of oral treprostinil in 2013 and selexipag in 2015 has allowed for earlier use of prostacyclins in combination therapy. 7 , 22 , 23 …”

“… 23 That study examined medication adherence and time to discontinuation of the index treatment regimen for newly diagnosed people. 23 A second study examined medication adherence, healthcare utilization, and cost using data through September 2017, however, the study was limited to people treated with oral prostacyclins. 24 The purpose of the current study is to examine treatment patterns, HCRU, and cost among health plan members with PAH beginning treatment since the 2015 update of the PAH treatment guidelines.…”