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Transitioning Patients with Pulmonary Hypertension from Tadalafil to Riociguat: Single-Center Experience

S. Paulus

A. Zeidler

N. Niebauer

Tammy Freichels

Tusneim Mohieldin

Michelle Cicona

Ker Vang

E. Roberts

Dianne Zwicke


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Conference: 2017 PH Professional Network Symposium

Release Date: 10.06.2017

Presentation Type: Abstracts

File Download: 2017 PHPN Abstract 1013

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Abstract presented at the 2017 PH Professional Network Symposium held in Bethesda, MD on October 5-7, 2017

Purpose

To study the effects of transitioning patients with pulmonary hypertension from tadalafil to riociguat therapy.

Background

Pulmonary Arterial Hypertension (PAH) is a devastating disease with increasing options for therapy. If a patient is not responding to a particular therapy, other options can be tried. Riociguat is an option to treat patients diagnosed with CTEPH (WHO Group 4) and PAH (WHO Group 1). We report our single center experience transitioning patients with CTEPH and PAH from tadalafil to riociquat.

Methods

We retrospectively reviewed the charts of patients transitioning from tadalafil to riociquat from November 2013 through March 2017.

Results

A total of 19 patients (average age 60.9 + 18 years; 11 females) with PAH (5 idiopathic, 6 congenital heart disease, and 4 collagen vascular disease) and CTEPH (n=4) transitioned from tadalafil to riociguat. The reasons for transition included attempting to augment PAH therapy (n=14), simplifying the medication regimen (2 therapies to 1; n=2), and the underlying etiology was CTEPH (n=4). Concomitant therapies were ERAs (n=5), prostacyclins (n=5), ERA + prostacyclin (n=2), and none (n=5). Compared to tadalafil, after 5.9 + 1.7 months on riociguat, 19 (of 19) patients’ average BP decreased (121/68 to 112/63), 6 min walk increased (462 m to 503 m), NYHA class decreased (3 to 2), PASP decreased (76mmHg to 74mmHg), and RAP, TAPSE, and RV size/function were unchanged. None of the changes were statistically significant (Table 1). Compared to tadalafil, after 12.5 + 1.4 months on riociguat, 11 (of 19) patients’ average BP decreased (121/68 to 111 /61), 6 min walk decreased (462 m to 414 m), PASP decreased (76mmHg to 73mmHg), RAP decreased (12 to 11), TAPSE decreased (18 to 17), and NYHA and RV size/function were unchanged. None of the changes were statistically significant (Table 1).

Conclusion

No statistically significant changes in BP, 6 min walk distance, NYHA class, or echo parameters were observed in our patient population transitioned from tadalafil to riociguat. Limitations to the study were small sample size and selection bias. Further and larger study is required to determine if there is any benefit in transitioning specific patient populations from tadalafil to riociguat.