Extract
儿童和成人的罕见病症,肺动脉高压(PAH)是进步的,并进行预后差[1,2]。治疗上,三个途径靶向诱导血管沉积,抑制血管增殖并减少右心的负荷:内皮素,一氧化氮和前列腺(PGI2) pathways [3]. Incident adult patients with severe PAH (i.e.with a high, >10% risk of 1-year mortality) are preferably treated with a parenteral PGI2analogue, while the double oral combination of a phosphodiesterase type-5 (PDE-5) inhibitor and an endothelin receptor antagonist (ERA) is considered standard of care for most other patients with mild to moderate PAH [1, 2, 4]. On the basis of the landmark AMBITION trial [5], PDE-5 inhibitor/ERA combination treatment is preferably started right after diagnosis (initial combination therapy). One small retrospective study in treatment-naïve, incident patients with severe PAH suggested exceptional benefit from initial triple combination therapy, consisting of a PDE-5 inhibitor, an ERA and intravenous epoprostenol [6]. This result was recently confirmed in a similar observational study of severe incident PAH patients treated with a combination including the subcutaneous PGI2analogue treprostinil [7]. The more recently developed prostacyclin receptor (IP) agonist selexipag was shown to improve outcomes in prevalent patients on initial mono- or combination therapy [8]. However, the benefit of initial triple combination therapy in treatment-naïve, mild-to-moderate PAH patients has not been established.
抽象的
Initial triple therapy benefits severe PAH patients across the ageshttps://bit.ly/3o9vB1G
脚注
兴趣冲突:H.J.博克德在研究期间,J&J的赠款和个人费用来自Ferrer和MSD的赠款和个人费用。
Conflict of interest: O. Sitbon reports grants, personal fees and non-financial support from Actelion Pharmaceuticals, personal fees from Acceleron, AOP Orphan, Ferrer and Gossamer Bio, grants and personal fees from Bayer and MSD, grants from GSK, outside the submitted work.
- 已收到11月18日2020年。
- AcceptedNovember 27, 2020.
- 复制right ©ERS 2021