Combination treatment can reduce rehospitalization risk in PAH: Study
Doctors rely heavily on monotherapy for all patients with disease
Adding more lines of treatment may reduce the risk of rehospitalization among adults with pulmonary arterial hypertension (PAH) who are taking only one medication, a study reports.
“Our results suggest that a shift away from monotherapy towards a greater reliance on combination therapy might help to reduce the risk of rehospitalization in PAH,” researchers wrote in the study, titled “Impact of treatment escalation on rehospitalization among patients with pulmonary arterial hypertension.” The study, published in Scientific Reports, was funded by Janssen Scientific Affairs, a part of Johnson & Johnson.
Study assesses impact of multiple treatments on PAH patients
PAH is a disorder marked by high blood pressure in the pulmonary arteries that carry blood from the heart to the lungs. The disease is associated with substantial health problems, and frequent hospitalizations are a common issue for people with PAH.
There are a variety of available treatments for PAH. Guidelines currently recommend starting with two or three different types of therapy in combination for patients without other cardiopulmonary disorders, the researchers noted. Those at intermediate-to-high risk with cardiopulmonary disorders should add PAH medications on an individual basis and as needed after initial therapy with a single agent.
However, “clinicians continue to heavily rely on monotherapy for the treatment of all patients with PAH, suggesting that the real-world management of PAH is currently suboptimal,” the scientists noted.
Being hospitalized is a predictor of poor outcomes in PAH, but data show most people with PAH continue on single therapy even after hospitalization, a finding the researchers call “particularly concerning.”
Here, the scientists conducted an analysis to see if adding a second treatment can reduce the risk of rehospitalization for PAH patients on monotherapy.
“The present study assessed the impact of treatment escalation on rehospitalization rates among treated PAH patients who had been hospitalized for PAH-related reasons in the US, with a particular focus among patients treated with monotherapy,” the researchers wrote.
Rehospitalization risk plummets for those on more than 1 therapy
The analysis included data on more than 1,450 people who were taking monotherapy and were hospitalized at least once. Most of the patients were specifically taking phosphodiesterase-5 inhibitors, namely Revatio (sildenafil) and Adcirca (tadalafil), as monotherapy.
After the initial hospitalization, 203 patients added one or more other types of treatment, while the other 1,252 continued with monotherapy. A vast majority of those who began combination therapy added one more oral medication (84.5%), with the remaining 15.5% adopting three treatments or more.
Earlier treatment escalation and the broader use of combination therapy to target multiple disease pathways has the potential to alleviate the substantial burden associated with PAH.
The researchers noted the use of monotherapy was very common even though combination treatment is recommended for many PAH patients. In fact, only 1 in 10 treated patients added a new therapy to their regimen after hospitalization, which the investigators said is consistent with prior data.
Statistical analyses showed the risk of rehospitalization was significantly lower, by approximately 31%, in patients who added one or more therapies than in those who continued with monotherapy.
“The high rate of monotherapy use post-hospitalization suggests hospitalization remains a missed opportunity to adjust therapy, albeit a late one, considering the strong evidence from clinical trials showing that proactive use of combination therapy can prevent disease progression events including hospitalization,” they wrote.
The most common reasons for rehospitalization were the same in both groups and included shortness of breath, unspecified pulmonary hypertension, and unspecified heart failure.
“Our findings indicate that treatment escalation may curb the frequency of rehospitalization among PAH patients, with pronounced results for patients initially treated with monotherapy escalating to combination therapy,” the researchers noted. “Given that hospitalizations are a key driver of economic burden and a marker of disease progression in PAH, earlier treatment escalation and the broader use of combination therapy to target multiple disease pathways has the potential to alleviate the substantial burden associated with PAH.”
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