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Eur Respir J. 2016 Jun;47(6):1727-36. doi: 10.1183/13993003.02043-2015. Epub 2016 Mar 17.

Initial dual oral combination therapy in pulmonary arterial hypertension.

Author information

1
Univ. Paris-Sud, Faculté de Médecine, Université Paris-Saclay, Le Kremlin-Bicêtre, France AP-HP, Service de Pneumologie, Hôpital Bicêtre, Le Kremlin-Bicêtre, France INSERM UMR_S 999, Hôpital Marie-Lannelongue, Le Plessis-Robinson, France olivier.sitbon@aphp.fr.
2
Univ. Paris-Sud, Faculté de Médecine, Université Paris-Saclay, Le Kremlin-Bicêtre, France AP-HP, Service de Pneumologie, Hôpital Bicêtre, Le Kremlin-Bicêtre, France INSERM UMR_S 999, Hôpital Marie-Lannelongue, Le Plessis-Robinson, France.
3
Service de Médecine Vasculaire et Thérapeutique, Hôpital Nord, CHU, Saint-Etienne, France Univ. Jean-Monnet, Groupe de Recherche sur la Thrombose (EA 3065), INSERM, CIC1408, Saint-Etienne, France.
4
Univ. Lyon-1, Hospices Civils de Lyon, Centre de Référence des maladies pulmonaires rares, Centre de Compétences de l'Hypertension Pulmonaire, Hôpital Louis Pradel, Lyon, France.
5
Hôpital Cardiologique de Lille, Centre de compétences de l'Hypertension Pulmonaire, Lille, France.
6
CHU Nancy, Pôle des spécialités médicales, Département de Pneumologie, Vandoeuvre-lès-Nancy, France Université de Lorraine, INGRES, EA 7298, Vandoeuvre-lès-Nancy, France.
7
CHU Rennes, Service de Cardiologie et Maladies Vasculaires, INSERM U1099, Rennes, France.
8
Hôpital Côte de Nacre, Centre de compétences Basse Normandie de l'Hypertension Pulmonaire, Université de Caen-Basse Normandie, Caen, France.
9
Centre Hospitalier Universitaire, Service de cardiologie, Grenoble, France.
10
CHU Clermont-Ferrand, Hôpital Gabriel Montpied, Service de cardiologie et maladies vasculaires, Clermont-Ferrand, France.
11
Université de Montpellier; INSERM U1046, UMR 9214, Hôpital Arnaud de Villeneuve, Service de pneumologie, Montpellier, France.
12
Cardiology Dept, Rouen University Health Centre, Rouen, France.

Abstract

Treatment for pulmonary arterial hypertension (PAH) has been underpinned by single-agent therapy to which concomitant drugs are added sequentially when pre-defined treatment goals are not met.This retrospective analysis of real-world clinical data in 97 patients with newly diagnosed PAH (86% in New York Heart Association functional class III-IV) explored initial dual oral combination treatment with bosentan plus sildenafil (n=61), bosentan plus tadalafil (n=17), ambrisentan plus tadalafil (n=11) or ambrisentan plus sildenafil (n=8).All regimens were associated with significant improvements in functional class, exercise capacity, dyspnoea and haemodynamic indices after 4 months of therapy. Over a median follow-up period of 30 months, 75 (82%) patients were still alive, 53 (71%) of whom received only dual oral combination therapy. Overall survival rates were 97%, 94% and 83% at 1, 2 and 3 years, respectively, and 96%, 94% and 84%, respectively, for the patients with idiopathic PAH, heritable PAH and anorexigen-induced PAH. Expected survival rates calculated from the French equation for the latter were 86%, 75% and 66% at 1, 2 and 3 years, respectively.Initial combination of oral PAH-targeted medications may offer clinical benefits, especially in PAH patients with severe haemodynamic impairment.

PMID:
26989105
DOI:
10.1183/13993003.02043-2015
[Indexed for MEDLINE]
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