Fewer PAH Hospitalizations With Uptravi Over Orenitram, Study Suggests

People with pulmonary arterial hypertension (PAH) who were treated with Uptravi (selexipag) had a lower risk and rate of hospitalization than those taking Orenitram (treprostinil), a real-world analysis revealed.

The study, “EXPRESS: Comparative effectiveness of oral prostacyclin-pathway drugs on hospitalization in patients with pulmonary hypertension in the United States: a retrospective database analysis,” was published in the journal Pulmonary Circulation.

Two oral prostacyclin-based therapies are currently prescribed for PAH: Orenitram, marketed by United Therapeutics, and Uptravi, sold by Actelion. Prostacyclin is a naturally occurring hormone that regulates blood pressure by relaxing and dilating blood vessels (vasodilator). 

Orenitram, though chemically identical to prostacyclin, is a human-made form of the hormone, while Uptravi is a molecule that works like prostacyclin, mimicking its effects.

Although the efficacy and safety of both of these therapies are well established, a head-to-head, real-world comparison has not been conducted. 

When such head-to-head data is not available, comparisons of real-world hospitalization data can be useful. To this end, scientists at Actelion, in collaboration with investigators at the Kentuckiana Pulmonary Research Center in Louisville, Ky., designed a study to compare the risk and rate of hospitalization of PAH patients prescribed Orenitram or Uptravi.

The real-world hospitalization data were sourced using the Optum Clinformatics Data Mart database, which houses medical and pharmaceutical administrative claims for the insured U.S. population. 

A total of 222 PAH patients were selected for analysis. Among them, 99 had been treated with Orenitram, for a median 0.59 years, and 123 received Uptravi for a median of 0.61 years. The study participants were an average of 61 years old and predominantly female (71%).

Compared with the Uptravi group, those receiving Orenitram had a higher prevalence of certain coexisting conditions, such as chronic obstructive pulmonary disease, known as COPD, diabetes, high blood lipids (fats), and depression. 

The analysis showed there were 147 all-cause (any cause) hospitalizations among the total patient population, with 79 people hospitalized at least once due to any cause. Additionally, there were 134 PAH-related hospitalizations, in which 75 patients experienced at least one hospitalization due to PAH.

Those prescribed Uptravi had a significantly lower risk of all-cause hospitalization and PAH-related hospitalization when compared with PAH patients treated with Orenitram.

After controlling for factors including age, gender, geographic region, insurance type, coexisting conditions, and additional PAH medications used, treatment with Uptravi was associated with a 46% lower risk of all-cause hospitalization and a 47% lower risk of PAH-related hospitalization compared to Orenitram therapy. 

The hospitalization rate — the number of hospitalizations per 100-person years — was 69.1 for those treated with Uptravi due to any cause and 63.2 for PAH-related hospitalizations. In comparison, the hospitalization rate for patients given Orenitram was 113.9 for any cause and 103.7 for hospitalizations due to PAH, the results showed. 

After controlling for confounding factors, Uptravi was associated with a 42% lower all-cause hospitalization rate and a 46% lower PAH-related hospitalization rate versus Orenitram. Confounding factors are something, other than the thing being studied, that could be causing the results seen in a study.

“In conclusion, in this real-world study, [Uptravi] was associated with a lower risk and rate of all-cause and PH-related hospitalization compared with [Orenitram],” the researchers wrote. “Controlled studies are recommended to confirm these findings.”