Treatment in PAH similar with, without mental health comorbidities

Key takeaways:

• Comparable proportions of patients with vs. without a mental health comorbidity took PAH monotherapy, dual therapy and triple therapy.
• Depression was reported by 22.9% of patients with PAH receiving selexipag.

BOSTON — Having pulmonary arterial hypertension plus a mental health comorbidity did not result in differing treatments or outcomes from those without this comorbidity, according to data presented at the CHEST Annual Meeting.

“These findings impact the everyday clinician by focusing on the need to consider mental health when treating patients with PAH,” Vallerie McLaughlin, MD, associate chief clinical officer and professor of internal medicine at University of Michigan Medical School, told Healio. “Despite mental health conditions thought to be frequently associated with poorer outcomes and higher medication discontinuation rates, their impact on patients with PAH has been poorly documented.

“This real-world evidence study analysis should reassure health care providers that patients with PAH and mental health conditions can be treated as actively as patients without these comorbidities,” McLaughlin said.

Using data from the SPHERE registry, McLaughlin and colleagues evaluated 759 adults with PAH receiving selexipag to find out how treatment and disease characteristics differ between patients with self-reported mental health comorbidities (n = 246) and patients without mental health comorbidities (n = 513).

Depression was reported by 22.9% of patients, followed by anxiety/anxiety disorder (14.7%) and bipolar disorder (1.2%), according to the abstract. When asked whether they received medication for their comorbid mental health disorder, 245 adults said yes.

After dividing the two groups based on the number of prior PAH-specific therapies received, researchers found comparable proportions of patients who took monotherapy (with mental health comorbidity, 33% vs. without mental health comorbidity, 28%), dual therapy (50% vs. 58%) and triple therapy (12% vs. 9%).

Notably, 45% of those without mental health comorbidities reported receipt of dual endothelial receptor antagonist-phosphodiesterase-5 inhibitor therapy, which was more than the 34% of those with mental health comorbidities.

Researchers also highlighted that from PAH diagnosis, it took longer for patients with vs. without mental health comorbidities to begin treatment with selexipag (3.3 years vs. 2.6 years).

“There might be room for improvement for earlier use of selexipag, which was delayed by approximately 8 months in patients with mental health conditions,” McLaughlin told Healio.

In terms of treatment specifics, those with mental health comorbidities and those without these comorbidities had the same median selexipag titration length (8.1 weeks) and individualized dose to be received two times a day (1,200 μg).

Nine percent of those with mental health comorbidities discontinued selexipag due to adverse events unrelated to PAH progression, and this was comparable to the 11% of patients without these comorbidities who discontinued the treatment for the same reason, according to the abstract.

The majority (57%) of those with mental health comorbidities fit into WHO functional class III at baseline. Following behind, 25% fit into WHO functional class II, 6% fit into functional class I and 5% fit into functional class IV.

Using REVEAL 2.0 to classify patients, researchers reported that 44% had low risk status, 34% had intermediate risk status and 22% had high risk status at baseline.

A stable WHO functional class was found in 62% of patients at 18 months, whereas a stable REVEAL 2.0 risk status was found in 28% of patients. Looking instead to improvement at 18 months, lower proportions of patients had an improved WHO functional class (25%), and an improved REVEAL 2.0 risk status (12%).

It took a shorter amount of time to first hospitalization in the group with vs. without mental health comorbidities (median, 10.7 months vs. 15.6 months), according to the abstract. Additionally, the mental health comorbidities group had a smaller proportion of patients who survived at 36 months (77% vs. 84%).

“This observational study of patients receiving selexipag shows that in real-world settings, patients with mental health conditions shared similar PAH-specific treatment patterns as patients without a mental health history and reported medication persistence and favorable outcomes with selexipag,” McLaughlin told Healio.

“This study may help address hesitation in treating patients with PAH who also suffer from mental health conditions and encourage a holistic approach to patient care,” McLaughlin said.

When interpreting these findings, researchers highlighted several limitations to keep in mind: missing data, potential inaccuracies in cohort formation, selection bias and lack of quality of life measures.