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Combination therapy reduces worsening for PAH patients

The use of combination pulmonary arterial hypertension therapy significantly reduced the risk for clinical worsening among patients with pulmonary arterial hypertension, according to a recent analysis.

“Combining PAH-targeted therapies significantly reduced the risk of clinical worsening, as predefined in clinical studies, for patients with PAH. This effect was generally consistent across subgroups,” Annie Christine Lajoie, MD, of the Pulmonary Hypertension Research Group and Institut Universitaire de Cardiologie et de Pneumologie de Québec Research Center in Canada, and colleagues wrote. “Combination therapy also reduced the risk for admission to hospital, treatment escalation, and symptomatic progression, and resulted in improved patient functional status.”

Lajoie and colleagues conducted a review of the MEDLINE, Embase and Cochrane Library databases for studies analyzing combination PAH and PAH-specific monotherapy between 1990 and 2015. They identified 17 prospective, randomized controlled trials comprising 4,095 patients, according to the abstract. Of these trials, 15 identified the primary outcome of clinical worsening.

The researchers found a significant reduction in the risk for developing clinical worsening for patients who underwent combined therapy (17%) compared with monotherapy (28%; RR = 0.65; 95% CI, 0.58-0.72). Although the Eggers test revealed a potential publication bias favoring positive results, the researchers noted the risk ratio was nearly identical when removing four studies with positive results. Lajoie and colleagues also observed no heterogeneity between studies. – by Jeff Craven

Disclosure: Lajoie reports lecture fees from Actelion Pharmaceuticals. Please see the full study for a complete list of all other researchers’ relevant financial disclosures.