Association Between Initial Treatment Strategy and Long-term Survival in Pulmonary Arterial Hypertension - Université Claude Bernard Lyon 1 Accéder directement au contenu
Article Dans Une Revue American Journal of Respiratory and Critical Care Medicine Année : 2021

Association Between Initial Treatment Strategy and Long-term Survival in Pulmonary Arterial Hypertension

1 Hypertension arterielle pulmonaire physiopathologie et innovation thérapeutique
2 Université Paris-Saclay
3 AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre)
4 EnVI - Endothélium, valvulopathies et insuffisance cardiaque
5 CHU Rouen
6 CHU Caen
7 UNICAEN - Université de Caen Normandie
8 LBTO - Biologie Intégrative du Tissu Osseux
9 CHU ST-E - Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne]
10 PhyMedExp - Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046]
11 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
12 CHUGA - Centre Hospitalier Universitaire [CHU Grenoble]
13 LTSI - Laboratoire Traitement du Signal et de l'Image
14 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Ponchaillou]
15 DCAC - Défaillance Cardiovasculaire Aiguë et Chronique
16 Service de Pneumologie [CHRU Nancy]
17 IVPC - Infections Virales et Pathologie Comparée - UMR 754
18 HCL - Hospices Civils de Lyon
19 CHU Gabriel Montpied [Clermont-Ferrand]
20 RID-AGE - Facteurs de Risque et Déterminants Moléculaires des Maladies liées au Vieillissement - U 1167
21 CHU Dijon - Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand
22 University of Calgary
23 CHU Nantes - Centre Hospitalier Universitaire de Nantes
24 Hôpital Nord Laennec [CHU Nantes]
25 CHU Trousseau [Tours]
26 Hôpital universitaire Robert Debré [Reims]
27 American Memorial Hospital (Hôpital des enfants) [Reims]
28 CHU Nice - Centre Hospitalier Universitaire de Nice
29 UniCA - Université Côte d'Azur
30 Hôpital Dupuytren [CHU Limoges]
31 Hôpital Haut-Lévêque [CHU Bordeaux]
32 UB - Université de Bordeaux
33 CHU La Réunion - Centre Hospitalier Universitaire de La Réunion
34 CHU Toulouse - Centre Hospitalier Universitaire de Toulouse
35 TIMONE - Hôpital de la Timone [CHU - APHM]
36 APHM - Assistance Publique - Hôpitaux de Marseille
37 AMU - Aix Marseille Université
38 Nouvel Hôpital Civil de Strasbourg
39 CHU de Poitiers - Centre hospitalier universitaire de Poitiers = Poitiers University Hospital
40 HEGP - Hôpital Européen Georges Pompidou [APHP]
41 CIC Brest
Sébastien Renard
  • Fonction : Auteur
  • PersonId : 771812
  • IdRef : 178990825
Olivier Sanchez
Cécile Tromeur
  • Fonction : Auteur
Jason Weatherald

Résumé

Rationale: The relationship between the initial treatment strategy and survival in pulmonary arterial hypertension (PAH) remains uncertain. Objectives: To evaluate the long-term survival of patients with PAH categorized according to the initial treatment strategy. Methods: A retrospective analysis of incident patients with idiopathic, heritable, or anorexigen-induced PAH enrolled in the French Pulmonary Hypertension Registry (January 2006 to December 2018) was conducted. Survival was assessed according to the initial strategy: monotherapy, dual therapy, or triple-combination therapy (two oral medications and a parenteral prostacyclin). Measurements and Main Results: Among 1,611 enrolled patients, 984 were initiated on monotherapy, 551 were initiated on dual therapy, and 76 were initiated on triple therapy. The triple-combination group was younger and had fewer comorbidities but had a higher mortality risk. The survival rate was higher with the use of triple therapy (91% at 5 yr) as compared with dual therapy or monotherapy (both 61% at 5 yr) (P < 0.001). Propensity score matching of age, sex, and pulmonary vascular resistance also showed significant differences between triple therapy and dual therapy (10-yr survival, 85% vs. 65%). In high-risk patients (n = 243), the survival rate was higher with triple therapy than with monotherapy or dual therapy, whereas there was no difference between monotherapy and double therapy. In intermediate-risk patients (n = 1,134), survival improved with an increasing number of therapies. In multivariable Cox regression, triple therapy was independently associated with a lower risk of death (hazard ratio, 0.29; 95% confidence interval, 0.11-0.80; P = 0.017). Among the 148 patients initiated on a parenteral prostacyclin, those on triple therapy had a higher survival rate than those on monotherapy or dual therapy. Conclusions: Initial triple-combination therapy that includes parenteral prostacyclin seems to be associated with a higher survival rate in PAH, particularly in the youngest high-risk patients.
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Dates et versions

hal-03274671 , version 1 (06-10-2021)

Identifiants

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Athénaïs Boucly, Laurent Savale, Xavier Jaïs, Fabrice Bauer, Emmanuel Bergot, et al.. Association Between Initial Treatment Strategy and Long-term Survival in Pulmonary Arterial Hypertension. American Journal of Respiratory and Critical Care Medicine, 2021, 204 (7), pp.842-854. ⟨10.1164/rccm.202009-3698OC⟩. ⟨hal-03274671⟩
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