@article {Dardi414, author = {Fabio Dardi and Alessandra Manes and Massimiliano Palazzini and Cristina Bachetti and Gaia Mazzanti and Andrea Rinaldi and Alessandra Albini and Enrico Gotti and Enrico Monti and Maria Letizia Bacchi Reggiani and Nazzareno Gali{\`e}}, title = {Combining bosentan and sildenafil in pulmonary arterial hypertension patients failing monotherapy: real-world insights}, volume = {46}, number = {2}, pages = {414--421}, year = {2015}, doi = {10.1183/09031936.00209914}, publisher = {European Respiratory Society}, abstract = {Pulmonary arterial hypertension is a severe disease with a complex pathogenesis, for which combination therapy is an attractive option.This study aimed to assess the impact of sequential combination therapy on both short-term responses and long-term outcomes in a real-world setting.Patients with idiopathic/heritable pulmonary arterial hypertension, or pulmonary arterial hypertension associated with congenital heart disease or connective tissue disease and who were not meeting treatment goals on either first-line bosentan or sildenafil monotherapy, were given additional sildenafil or bosentan and assessed after 3{\textendash}4 months. Double combination therapy significantly improved clinical and haemodynamic parameters, independent of aetiology or the order of drug administration. Significant improvements in functional class were observed in patients with idiopathic/heritable pulmonary arterial hypertension. The 1-, 3- and 5-year overall survival estimates were 91\%, 69\% and 59\%, respectively. Patients with pulmonary arterial hypertension associated with connective tissue disease had significantly poorer survival rates compared to other aetiologies (p\<0.003).The favourable short-term haemodynamic results and good survival rates, observed in patients receiving both bosentan and sildenafil, supports the use of sequential combination therapy in patients failing on monotherapy in a real-world setting.Bosentan and sildenafil combination therapy improved haemodynamics and exercise in PAH patients failing monotherapy http://ow.ly/LGrPm}, issn = {0903-1936}, URL = {https://erj.ersjournals.com/content/46/2/414}, eprint = {https://erj.ersjournals.com/content/46/2/414.full.pdf}, journal = {European Respiratory Journal} }