Managing pulmonary arterial hypertension

A new treatment strategy may be effective in controlling pulmonary arterial hypertension, a disease known to progress to right ventricular heart failure or premature mortality.

In the Phase 3 Advance Outcomes trial published in The Lancet, researchers randomly assigned more than 700 adult patients with pulmonary arterial hypertension to receive either the oral, selective nonprostanoid prostacyclin receptor agonist ralinepag or placebo once per day. The participants who received ralinepag initiated 50 micrograms of the drug and titrated treatment every week until they reached the maximum tolerated dose per individual.

The researchers found that compared with those who received placebo, the participants who received ralinepag experienced fewer clinical worsening events — including disease progression, unsatisfactory long-term clinical response, initiation of parenteral or inhaled prostacyclin-pathway therapy, hospital admission related to worsening pulmonary arterial hypertension or right ventricular heart failure, or all-cause mortality — but a higher rate of treatment discontinuations related to adverse events. Further, the participants who received ralinepag were more likely to experience improvements in their N-terminal proB-type natriuretic peptide levels and exercise capacity through the six-minute walk distance test. The rates of serious adverse events and adverse events resulting in mortality were comparable between both treatment groups.

The findings demonstrated the potential efficacy of ralinepag in this patient population. Further studies will be needed to better understand the comparative safety and efficacy of ralinepag versus currently approved pulmonary arterial hypertension therapies.

Read more: The Lancet

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