Is Upfront Triple Combination Therapy in PAH "A Thing"?

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Presentation transcript:

Is Upfront Triple Combination Therapy in PAH "A Thing"? Vallerie V. McLaughlin, MD, FACC, FAHA, FCCP Kim A. Eagle, MD, Endowed Professor of Cardiovascular Medicine Director, Pulmonary Hypertension Program University of Michigan Health System Ann Arbor, Michigan, USA

Upfront Triple Combination Therapy: Pilot Study of the Effect on Hemodynamics Upfront triple combo therapy: i.v. epoprostenol + bosentan + sildenafil 19 incident (i.e. newly diagnosed) patients with Idiopathic (n=9) or heritable (n=10) PAH Mean age 39 ± 14 years (18–63) NYHA FC III (n=8) or IV (n=11) Severe hemodynamics: CI < 2.0 L/min/m2 or PVR > 1000 d.s.cm-5 Sitbon O, Jaîs X, Savale L, et al. Upfront triple combination therapy in pulmonary arterial hypertension: a pilot study. Eur Respir J. 2014;43:1691-1697.

Upfront Triple Combination Therapy: Effect on Hemodynamics Prospective, observational analysis of idiopathic or heritable PAH patients (n = 19) treated with upfront combination therapy (epoprostenol, bosentan and sildenafil) N=18 Baseline 4-month Last visit (32 ± 19 months) RAP (mmHg) 11.9 ± 5.2 4.9 ± 4.9* 5.2 ± 3.5* mPAP (mmHg) 65.8 ± 13.7 45.7 ± 14.0* 44.4 ± 13.4* PCWP (mmHg) 8.4 ± 3.5 6.7 ± 3.2 7.9 ± 2.8 CI (l/min/m2) 1.66 ± 0.35 3.49 ± 0.69* 3.64 ± 0.65* PVR (d.s.cm-5) 1718 ± 627 564 ± 260* 492 ± 209* Heart rate (bpm) 92.3 ± 10.7 83.9 ± 9.8* 79.9 ± 13.4* Mean BP (mmHg) 92.1 ± 12.5 80.1 ± 11.7* 84.9 ± 19.4 SvO2 (%) 51.0 ± 8.5 69.7 ± 5.2* 72.2 ± 4.0* *P <0.01 versus baseline Sitbon O, Jaîs X, Savale L, et al. Upfront triple combination therapy in pulmonary arterial hypertension: a pilot study. Eur Respir J. 2014;43:1691-1697.