Abstract
Background: Initial combination treatment with ambrisentan and tadalafil (up-front therapy) offers clinical benefits in pulmonary arterial hypertension (PAH) and reduces the risk of clinical failure compared with monotherapy in naive patients.
Aims: To assess the efficacy of 12 month up-front therapy with ambrisentan and tadalafil to improve hemodynamic changes in incident PAH patients.
Methods: This is a multicentre retrospective analysis of real-world Italian clinical data in 56 patients with newly diagnosed PAH.
Clinical evaluation, including demographics, medical history, World Health Organization (WHO) functional class, 6-minutes walk distance (6MWD), and right heart catheterization (RHC) were collected from medical records at baseline and 12 month of follow up.
Results: WHO functional class at baseline was: II in 12 patients, III in 38 and IV in 6.
Over a median follow-up period of 12 months, 53 (95%) patients are still alive, 6 (11%) of whom received parenteral prostanoids.
Ambrisentan-tadalafil association was a associated with significant improvements in WHO-functional class (2.2±0.8 vs 2.8±0.6, p<0.001, improved in 27 patients), exercise capacity (395 ±123 vs 353±101, p=0.039) and haemodynamic indices (RAP 7±4 vs 9±9 mmHg, p=0.020; mPAP 45±15 vs 50±13 mmHg, p=0.033; CI 3.0±1.0 vs 2.5±0.9, p=0.001; PVR 7.7±4.4 vs 10.7±5.8, p=0.001).
Conclusion: This study shows that initial combination with oral medications ambrisentan and tadalafil offers clinical benefits, and significant haemodynamic improvement in newly diagnosed PAH patients.
- Copyright ©the authors 2017