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Mono and combination therapies in pulmonary arterial hypertension patients with comorbidities: a COMPERA analysis

Aims Pulmonary arterial hypertension (PAH) is often diagnosed in elderly patients with comorbidities. Although initial monotherapy is recommended for these patients, the value of combination therapy remains unclear. Here, we compare the efficacy of initial monotherapy and combination therapy in PAH...

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Main Authors: Skowasch, Dirk (Author) , Pausch, Christine (Author) , Huscher, Doerte (Author) , Pittrow, David (Author) , Wede, Judith (Author) , Kreimendahl, Fabian (Author) , Rosenkranz, Stephan (Author) , Beckmann, Stephan (Author) , Held, Matthias (Author) , Grünig, Ekkehard (Author) , Ghofrani, H. Ardeschir (Author) , Klose, Hans (Author) , Skride, Andris (Author) , Halank, Michael (Author) , Stadler, Stefan (Author) , Delcroix, Marion (Author) , Vonk-Noordegraaf, Anton (Author) , Ewert, Ralf (Author) , Kopec, Grzegorz (Author) , Hoeper, Marius M. (Author) , Olsson, Karen M. (Author)
Format: Article (Journal)
Language:English
Published: August 2025
In: ESC heart failure
Year: 2025, Volume: 12, Issue: 4, Pages: 2726-2735
ISSN:2055-5822
DOI:10.1002/ehf2.15254
Online Access:Verlag, kostenfrei, Volltext: https://doi.org/10.1002/ehf2.15254
Verlag, kostenfrei, Volltext: https://onlinelibrary.wiley.com/doi/abs/10.1002/ehf2.15254
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Author Notes:Dirk Skowasch, Christine Pausch, Doerte Huscher, David Pittrow, Judith Wede, Fabian Kreimendahl, Stephan Rosenkranz, Stephan Beckmann, Matthias Held, Ekkehard Grünig, H. Ardeschir Ghofrani, Hans Klose, Andris Skride, Michael Halank, Stefan Stadler, Marion Delcroix, Anton Vonk-Noordegraaf, Ralf Ewert, Grzegorz Kopec, Marius M. Hoeper, and Karen M. Olsson
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Summary:Aims Pulmonary arterial hypertension (PAH) is often diagnosed in elderly patients with comorbidities. Although initial monotherapy is recommended for these patients, the value of combination therapy remains unclear. Here, we compare the efficacy of initial monotherapy and combination therapy in PAH patients with cardiovascular comorbidities. Methods and results Data from adult patients with incident pre-capillary PAH and cardiovascular comorbidities from the COMPERA database (European registry for PH) were analysed. A matched-pair analysis of patients treated with monotherapy versus combination therapy based on age, sex, WHO functional class (FC) and 4-strata risk at baseline was performed. The matching strategy identified 216 pairs of PAH patients with cardiovascular comorbidities, who differed considerably from the enrolled patient population (n = 1871), especially in terms of mean age (mono: matched pairs 62.9 ± 13.5 years vs. 70.6 ± 11.4 years, combination: matched pairs 62.0 ± 13.6 years vs. 60.5 ± 14.9 years). In the matched-pair analysis, the initial combination therapy group showed more pronounced improvements in WHO-FC, N-terminal pro-B-type natriuretic peptide (BNP/NT-proBNP) and risk status than patients treated with initial monotherapy, with no significant differences in 6-min walk distance (6MWD), PAH-related hospitalisations, survival and drug discontinuation. Conclusions This analysis suggests that PAH patients with comorbidities may benefit more pronounced from combination therapy regarding WHO-FC, BNP/NT-pro-BNP and risk status without a significant difference in survival. Good tolerability is indicated. However, given the relatively younger patient matched subgroup, these findings may not necessarily apply to older patients with a wider range of comorbidities.
Item Description:Veröffentlicht: 04 March 2025
Gesehen am 15.09.2025
Physical Description:Online Resource
ISSN:2055-5822
DOI:10.1002/ehf2.15254

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