• About
  • Masthead
  • License Content
  • Advertise
  • Submit Press Release
  • RSS/Email List
  • 2MM Podcast
  • Write for us
  • Contact Us
2 Minute Medicine
No Result
View All Result

No products in the cart.

SUBSCRIBE
  • Specialties
    • All Specialties, All Recent Reports
    • Cardiology
    • Chronic Disease
    • Dermatology
    • Emergency
    • Endocrinology
    • Gastroenterology
    • Imaging and Intervention
    • Infectious Disease
    • Nephrology
    • Neurology
    • Obstetrics
    • Oncology
    • Ophthalmology
    • Pediatrics
    • Pharma
    • Preclinical
    • Psychiatry
    • Public Health
    • Pulmonology
    • Rheumatology
    • Surgery
  • AI Roundup
  • Pharma
  • The Scan+
  • Classics™+
    • 2MM+ Online Access
    • Paperback and Ebook
  • Rewinds
  • Visual
  • Podcasts
  • Partners
    • License Content
    • Submit Press Release
    • Advertise with Us
  • Account
    • Subscribe
    • Sign-in
    • My account
2 Minute Medicine
  • Specialties
    • All Specialties, All Recent Reports
    • Cardiology
    • Chronic Disease
    • Dermatology
    • Emergency
    • Endocrinology
    • Gastroenterology
    • Imaging and Intervention
    • Infectious Disease
    • Nephrology
    • Neurology
    • Obstetrics
    • Oncology
    • Ophthalmology
    • Pediatrics
    • Pharma
    • Preclinical
    • Psychiatry
    • Public Health
    • Pulmonology
    • Rheumatology
    • Surgery
  • AI Roundup
  • Pharma
  • The Scan+
  • Classics™+
    • 2MM+ Online Access
    • Paperback and Ebook
  • Rewinds
  • Visual
  • Podcasts
  • Partners
    • License Content
    • Submit Press Release
    • Advertise with Us
  • Account
    • Subscribe
    • Sign-in
    • My account
SUBSCRIBE
2 Minute Medicine
Subscribe
Home All Specialties Cardiology

Combination therapy associated with improved outcomes in pulmonary arterial hypertension

byMatthew GrowdonandShaidah Deghan, MSc. MD
August 28, 2015
in Cardiology, Chronic Disease, Pulmonology
Reading Time: 3 mins read
0
Share on FacebookShare on Twitter

1. Combination therapy with ambrisentan and tadalafil in patients with pulmonary arterial hypertension was associated with a 50% decrease in the primary outcome of first event of clinical failure over the follow-up period.

2. Combination therapy was not associated with a significant benefit in terms of change in WHO functional class at week 24.

Evidence Rating Level: 1 (Excellent)      

Study Rundown: Current therapies for pulmonary arterial hypertension (PAH) target one of three pathways: the prostacyclin, nitric oxide, or endothelin pathways. Previous studies have examined the sequential addition of therapies addressing each pathway in subjects with PAH. In this randomized controlled study involving 500 participants (in primary analysis), the investigators compared the use of combined ambrisentan (selective endothelin-A receptor antagonist) and tadalafil (a phosphodiesterase type 5 inhibitor) to monotherapy with each agent alone.

The primary end point for the time-to-event analysis was the first event of clinical failure, defined as the first occurrence of a composite of death, hospitalization for worsening PAH, disease progression, or an unsatisfactory long-term clinical response. The hazard ratio comparing the combined therapy group to the pooled monotherapy groups was 0.50, in favor of combination therapy; this benefit of combo therapy was seen for other outcomes including greater reduction in pro-brain natriuretic peptide levels and percentage of patients with a satisfactory clinical response. There was no statistically significant change in WHO functional class at week 24 across the comparison groups.

This study derives its strength from its relatively large size and its randomized design. It also substantiates the hypothesis that PAH could be treated by targeting multiple pathophysiologic mechanisms at once. The findings are hampered by a few quirks in the design. Notably, the authors instituted a post hoc amendment to exclude subjects with left ventricular diastolic dysfunction causing PAH, which limits the generalizability of the findings.

RELATED REPORTS

Time-restricted eating does not confer changes in sleep, mood, or quality of life

Commonly cited medication triggers may not increase risk of microscopic colitis among older adults

Ablation may reduce stroke risk, death, heart failure hospitalization in patients with atrial fibrillation

Click to read the study, published today in NEJM

Relevant Reading: Diagnosis and assessment of pulmonary arterial hypertension

In-Depth [randomized controlled trial]: This randomized controlled study initially began with 610 subjects randomized to either receive combination therapy with ambrisentan and tadalafil, or monotherapy with one of these agents. Subjects were18 to 75 years of age (mean age 54.4 years, 78% female) and had WHO functional class II or III symptoms of PAH (idiopathic, hereditary, or PAH associated with connective tissue disease, drugs, toxins, HIV, or repaired congenital heart defects). The mean pulmonary artery pressure was 48.7 mmHg. The analysis was carried out on 500 subjects who met amended entry requirements excluding those whose PAH may have been due to left ventricular dysfunction.

In terms of the primary outcome, the hazard ratio comparing the combination-therapy group to pooled monotherapy groups was 0.50 (95% [CI], 0.35 to 0.72; p<0.001); the hazard ratio for this comparison in terms of NT-proBNP levels, satisfactory clinical response at week 24, and 6-minute walk distance were all statistically significant as well. The comparison for change in WHO functional class at week 24 did not reach significance (p=0.24). Interestingly, the Kaplan-Meyer event curves for the combination versus pooled monotherapy groups in terms of primary outcome separate around 24 weeks but appear to converge somewhat after 144 weeks. The most common side effects in the combination therapy group included peripheral edema, headache, nasal congestion, and anemia.

Image: PD

©2015 2 Minute Medicine, Inc. All rights reserved. No works may be reproduced without expressed written consent from 2 Minute Medicine, Inc. Inquire about licensing here. No article should be construed as medical advice and is not intended as such by the authors or by 2 Minute Medicine, Inc.

Previous Post

Teens identifying with goth subculture at higher risk of depression and self-harm

Next Post

No significant improvement in older adult cognitive function with moderate physical activity

RelatedReports

Provision of medically-tailored meals linked with lower admissions and medical spending
Chronic Disease

Time-restricted eating does not confer changes in sleep, mood, or quality of life

July 4, 2025
Multiple opioid prescriptions associated with higher hospital admissions
Gastroenterology

Commonly cited medication triggers may not increase risk of microscopic colitis among older adults

July 4, 2025
Atrial fibrillation-specific management increases days alive and out of hospital
Cardiology

Ablation may reduce stroke risk, death, heart failure hospitalization in patients with atrial fibrillation

July 4, 2025
All Specialties

Minimally invasive surgery is beneficial for epithelial ovarian cancer 

July 4, 2025
Next Post
No significant improvement in older adult cognitive function with moderate physical activity

No significant improvement in older adult cognitive function with moderate physical activity

Radiographic surrogates may predict tumor-specific survival in renal carcinoma

Radiographic surrogates may predict tumor-specific survival in renal carcinoma

Infertility treatments not associated with increased short-term cancer risk

More live births after natural cycle IVF

2 Minute Medicine® is an award winning, physician-run, expert medical media company. Our content is curated, written and edited by practicing health professionals who have clinical and scientific expertise in their field of reporting. Our editorial management team is comprised of highly-trained MD physicians. Join numerous brands, companies, and hospitals who trust our licensed content.

Recent Reports

  • Time-restricted eating does not confer changes in sleep, mood, or quality of life
  • Commonly cited medication triggers may not increase risk of microscopic colitis among older adults
  • Ablation may reduce stroke risk, death, heart failure hospitalization in patients with atrial fibrillation
License Content
Terms of Use | Disclaimer
Cookie Policy
Privacy Statement (EU)
Disclaimer

© 2021 2 Minute Medicine, Inc. - Physician-written medical news.

  • Specialties
    • All Specialties, All Recent Reports
    • Cardiology
    • Chronic Disease
    • Dermatology
    • Emergency
    • Endocrinology
    • Gastroenterology
    • Imaging and Intervention
    • Infectious Disease
    • Nephrology
    • Neurology
    • Obstetrics
    • Oncology
    • Ophthalmology
    • Pediatrics
    • Pharma
    • Preclinical
    • Psychiatry
    • Public Health
    • Pulmonology
    • Rheumatology
    • Surgery
  • AI Roundup
  • Pharma
  • The Scan
  • Classics™
    • 2MM+ Online Access
    • Paperback and Ebook
  • Rewinds
  • Visual
  • Podcasts
  • Partners
    • License Content
    • Submit Press Release
    • Advertise with Us
  • Account
    • Subscribe
    • Sign-in
    • My account
No Result
View All Result

© 2021 2 Minute Medicine, Inc. - Physician-written medical news.