Combination Therapy in Pulmonary Arterial Hypertension: Single Centre Long-term Experience

Area of Science:

• Cardiology
• Pulmonology
• Pharmacology

Background:

• Pulmonary arterial hypertension (PAH) is a progressive condition leading to right heart failure and death.
• Combination therapy is often necessary for PAH due to its progressive nature.
• Treatment approaches include "first-line up-front" and "sequential add-on" strategies, with limited evidence on their comparative efficiency and safety.

Purpose of the Study:

• To evaluate the effectiveness and safety of different treatment approaches in patients with pulmonary arterial hypertension (PAH).
• To compare monotherapy versus combination therapy in managing PAH at a tertiary care center.

Main Methods:

• Diagnosis of PAH confirmed via clinical, echocardiographic, and right heart catheterization findings.
• Patients received bosentan, sildenafil, and iloprost according to treatment guidelines.
• Clinical worsening defined by mortality, hospitalization, 6-minute walk test decline, functional deterioration, or right heart failure.

Main Results:

• No significant differences in clinical, echocardiographic, BNP levels, or oxygen saturation between monotherapy and combination therapy groups.
• Patients requiring combination treatment had a significantly longer follow-up period.
• At follow-up, 34.5% received monotherapy, 51.7% received dual therapy, and 13.8% received triple therapy.

Conclusions:

• Sequential add-on combination therapy was utilized in this PAH cohort.
• Monotherapy was sufficient for 34.5% of patients; 48.4% achieved stability with dual therapy.
• A smaller proportion (12.9%) required triple drug combination therapy for PAH management.