患有低风险肺动脉高血压的患者是否真的受益于前期组合疗法? : 野心审判中的洞察力
Charles Fauvel1, Yongqi Liu2, Priscilla Correa-Jaque3
1Division of Cardiovascular Medicine, Wexner Medical Center, The Ohio State University, Columbus, OH; Department of Cardiology, Normandie University, UNIROUEN, Rouen, France.
对低风险肺动脉高血压 (PAH) 的前期组合疗法在预防临床恶化方面没有显著的益处. 患者经历了更多的副作用,这表明在开始这种治疗之前可能需要进一步的风险分层.
科学领域:
- 心脏病学 心脏病学
- 肺部病理学 肺部病理学
- 药理学 药理学是指药理学的学科.
背景情况:
- 目前的指导方针建议在AMBITION试验的基础上,对未经治疗的低风险肺动脉高血压 (PAH) 进行预先组合治疗.
- 关于这种策略在低风险PAH患者中的益处和耐受性,存在相互矛盾的数据.
研究的目的:
- 在低风险的PAH患者中,评估前期组合治疗与单一治疗的疗效和安全性.
- 确定当前的风险分层工具是否足够识别了从前期组合治疗中受益的患者.
主要方法:
- 对AMBITION试验数据的回顾性分析.
- 用REVEAL 2.0分数和PHORA工具对患者进行风险分层.
- 主要终点:临床恶化的时间 (死亡,住院,进展);次要终点:与治疗相关的副作用.
主要成果:
- 与单独治疗相比,接受前期组合治疗的低风险PAH患者在1年或3年内没有显示出在临床恶化之前的统计学上显著的益处.
- 在前期组合治疗组中观察到更高的副作用发生率,尽管在统计学上并不显著.
- 中期和高风险的PAH患者表现出前期组合治疗的统计学上显著益处.
结论:
- 前期组合疗法可能不会对所有低风险PAH患者有好处,并可能增加副作用的发生率.
- 进一步的风险分层方法可能是必要的,以确定适合的候选人在低风险的PAH前期组合治疗.
- 在改变当前治疗指南之前,需要进行前性研究来验证这些发现.
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