Study of 2 Treatments for PAH Finds 1 Reduces Risk of Hospitalization

Compared with treprostinil, selexipag carried a 47% reduced risk of pulmonary arterial hypertension (PAH)-related hospitalization and 46% reduced risk of all-cause hospitalization.

A real-world comparison of the 2 FDA-approved treatments for pulmonary arterial hypertension (PAH) is offering insight into related hospitalizations for patients taking either treatment.

The study, relying on administrative claims from over 200 patients receiving either treprostinil (Orenitram) or selexipag (Uptravi) between January 2015 and September 2017, showed that selexipag is associated with a lower risk of hospitalization for patients with PAH.

“These results provide real-world evidence suggesting the two available oral agents targeting the prostacyclin pathway may yield different clinical outcomes, specifically all-cause and PH-related hospitalizations,” wrote the researchers.

Compared with treprostinil, selexipag carried a 47% reduced risk of PH-related hospitalization and 46% reduced risk of all-cause hospitalization.

Crude rates of PAH-related hospitalizations were significantly lower among patients receiving selexipag, which was associated with a rate of 63.2 hospitalizations per 100 person-years compared with a rate of 103.7 hospitalizations per 100 person-years among patients receiving treprostinil.

Findings were similar for all-cause hospitalizations, with selexipag being associated with 69.1 hospitalizations per 100 person-years compared with 113.9 hospitalizations per 100-years associated with treprostinil.

According to the researchers, this finding may potentially be attributable to the proven challenge of achieving a clinically effective oral dose of treprostinil in clinical practice. Compared with prostanoids, selexipag has demonstrated superior selectivity for the IP receptor, resulting in reduced gastrointestinal intolerance, a noted dose-limiting side effect of oral treprostinil.

Throughout the study period, there were a total of 134 PAH-related and 147 all-cause hospitalizations over 162.05 person-years of follow-up. There were 75 patients who had at least 1 PAH-related hospitalization and 79 who had at least 1 all-cause hospitalization.

“Clinical guidelines current during the study period gave a Class I (Evidence Level B) recommendation to selexipag for patients with PAH in World Health Organization (WHO) Functional Class (FC) II or III, and a Class IIb (Evidence Level B) recommendation to oral treprostinil for patients in WHO FC III,” wrote the researchers. “It is unknown to what extent prescribers may have selected different patients for treatment with oral treprostinil vs. selexipag in accordance with these recommendations, because WHO FC was not recorded in the database.”

The researchers noted that the group of patients receiving treprostinil tended to be older and have more comorbidities; however, even after adjusting for these factors, the risk of hospitalization remained favorable for selexipag. They added that the results should not be impacted by the prevalence of connective tissue disease, which was similar between patients receiving selexipag and treprostinil (24.4% vs 28.3%, respectively).


McConnell J, Tsang Y, Pruett J, Drake III W. Comparative effectiveness of oral prostacyclin-pathway drugs on hospitalization in patients with pulmonary hypertension in the United States: a retrospective database analysis. Pulm Circ. Published online November 10, 2020. doi:10.1177/2045894020911831.