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Am J Respir Crit Care Med. 2015 Nov 1;192(9):1111-7. doi: 10.1164/rccm.201507-1456OC.

Comparison of Treatment Response in Idiopathic and Connective Tissue Disease-associated Pulmonary Arterial Hypertension.

Author information

1
1 Division of Rheumatology.
2
2 Center for Clinical Epidemiology and Biostatistics, and.
3
3 Pulmonary, Allergy, and Critical Care Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.

Abstract

RATIONALE:

Studies suggest that patients with connective tissue disease-associated pulmonary arterial hypertension (CTD-PAH) have a poorer treatment response to therapies for PAH compared with patients with idiopathic PAH (IPAH), but individual randomized controlled trials (RCTs) have been underpowered to examine differences within these subgroups.

OBJECTIVES:

To compare the effect of therapy for PAH in CTD-PAH versus IPAH.

METHODS:

We obtained individual participant data from phase III placebo-controlled RCTs of therapies for PAH submitted to the U.S. Food and Drug Administration for drug approval. A treatment-by-diagnosis interaction term evaluated differences in treatment response between CTD-PAH and IPAH. Outcomes included change in 6-minute-walk distance (∆6MWD) from baseline to 12 weeks, clinical worsening, and all-cause mortality.

MEASUREMENTS AND MAIN RESULTS:

The study sample included 827 participants with CTD-PAH and 1,935 with IPAH from 11 RCTs. Patients with CTD-PAH had less improvement in 6MWD when assigned to active treatment versus placebo compared with patients with IPAH (difference in treatment effect on ∆6MWD in CTD-PAH vs. IPAH, -17.3 m; 90% confidence interval, -31.3 to -3.3; P for interaction = 0.043). Treatment was less effective in reducing the occurrence of clinical worsening in CTD-PAH versus IPAH (P for interaction = 0.012), but there was no difference in the placebo-adjusted effect of treatment on mortality (P for interaction = 0.65).

CONCLUSIONS:

Treatment for PAH was less effective in CTD-PAH compared with IPAH in terms of increasing 6MWD and preventing clinical worsening. The heterogeneity of treatment response supports the need for identifying therapies that are more effective for CTD-PAH.

KEYWORDS:

clinical trial; meta-analysis; pulmonary hypertension

PMID:
26291092
PMCID:
PMC4642205
DOI:
10.1164/rccm.201507-1456OC
[Indexed for MEDLINE]
Free PMC Article

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