Exploring Early Combination Therapy in PAH
Program Overview
Assessing Risk of Disease Progression in PAH
A Multi-Parameter Risk Assessment Is Needed
Comprehensive Prognostic Evaluation and Risk Assessment
Risk Assessment in PAH
Risk Assessment Is Fundamental for Determining an Optimal Treatment Strategy
Case Example: 25-Year-Old Woman With Heritable PAH*
2015 ESC/ERS Guidelines: Risk Stratification in PAH
Mortality in PAH: Prediction by the 2015 European PH Guidelines Risk Stratification Model
PAH Risk Assessment and Survival in COMPERA
PAH Risk Assessment and Survival in COMPERA
Risk Assessment, Prognosis, and Guideline Implementation in PAH
Risk Assessment and Survival: The French Registry
Variables Associated With a Higher Risk of Death or Transplantation
Variables Associated With a Higher Risk of Death or Transplantation (cont)
Risk Assessment and Survival: The French Registry (cont)
2015 ESC/ERS Guidelines: Goal of Therapy
Using the Risk Stratification Table From the ESC/ERS PH Guidelines: Practical Recommendations
Patient Risk: NYHA FC I/II Is Still Advanced Disease
Patient Risk: NYHA FC Is Still Advanced Disease (cont)
AMBITION: Disease Severity at Baseline*
AMBITION*: Significant Improvement in Outcomes With Initial Ambrisentan + Tadalafil
AMBITION: Initial Combination Therapy in Patients With FC II or III PAH
24-Year-Old "Asymptomatic" BMPR 2 Mutation Carrier Diagnosed With PAH During Screening
24-Year-Old "Asymptomatic" BMPR 2 Mutation Carrier Diagnosed With PAH During Screening (cont)
24-Year-Old "Asymptomatic" BMPR 2 Mutation Carrier Diagnosed With PAH During Screening (cont)
PAH Progresses Rapidly in Patients on Monotherapy
AMBITION: First Adjudicated Clinical Failure by Subgroup
2015 ESC/ERS Guidelines: Combination Therapy Is Widely Recommended and Supported by Clinical Trial Data
Hemodynamic Effects of Different Types of Initial Oral Combination Therapy in PAH
Ambrisentan + Tadalafil: Improved Outcomes With Initial Combination Therapy vs Monotherapy*
Bosentan + Tadalafil: Improved Outcomes With Initial Combination Therapy vs Monotherapy*
Initial Dual Oral Combination Therapy: All Regimens Were Associated With Improved HDs
OPTIMA*: Combination Therapy With Macitentan and Tadalafil Led to Improvements in HDs and FC
Summary: Treatment Recommendations
Residual Role of Monotherapy in a Minority of PAH Subsets
Potential Barriers to Starting Initial Combination Therapy
AMBITION: AEs Leading to Treatment Discontinuation
Potential Barriers to Starting Initial Combination Therapy (cont)
Potential Barriers to Starting Initial Combination Therapy (cont)
Potential Barriers to Starting Initial Combination Therapy (cont)
Potential Barriers to Starting Initial Combination Therapy (cont)
Common AEs of Initial Combination Therapy
Managing Potential AEs
Conclusions
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