| Title: |
Association Between Initial Treatment Strategy and Long-term Survival in Pulmonary Arterial Hypertension |
| Authors: |
Boucly, Athénaïs; Savale, Laurent; Jaïs, Xavier; Bauer, Fabrice; Bergot, Emmanuel; Bertoletti, Laurent; Beurnier, Antoine; Bourdin, Arnaud; Bouvaist, Hélène; Bulifon, Sophie; Chabanne, Céline; Chaouat, Ari; Cottin, Vincent; Dauphin, Claire; Degano, Bruno; de Groote, Pascal; Favrolt, Nicolas; Feng, Yuanchao; Horeau-Langlard, Delphine; Jevnikar, Mitja; Jutant, Etienne-Marie; Liang, Zhiying; Magro, Pascal; Mauran, Pierre; Moceri, Pamela; Mornex, Jean-François; Palat, Sylvain; Parent, Florence; Picard, François; Pichon, Jérémie; Poubeau, Patrice; Prévot, Grégoire; Renard, Sébastien; Reynaud-Gaubert, Martine; Riou, Marianne; Roblot, Pascal; Sanchez, Olivier; Seferian, Andrei; Tromeur, Cécile; Weatherald, Jason; Simonneau, Gérald; Montani, David; Humbert, Marc; Sitbon, Olivier |
| Contributors: |
Hypertension arterielle pulmonaire physiopathologie et innovation thérapeutique (HPPIT); Université Paris-Sud - Paris 11 (UP11)-Centre Chirurgical Marie Lannelongue (CCML)-Institut National de la Santé et de la Recherche Médicale (INSERM); Université Paris-Saclay; Hôpital Bicêtre AP-HP, Le Kremlin-Bicêtre; Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP); Endothélium, valvulopathies et insuffisance cardiaque (EnVI); Université de Rouen Normandie (UNIROUEN); Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM); CHU Rouen; Normandie Université (NU); CHU Caen Normandie – Centre Hospitalier Universitaire de Caen Normandie (CHU Caen Normandie); Université de Caen Normandie (UNICAEN); Biologie Intégrative du Tissu Osseux (LBTO); Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM); Centre Hospitalier Universitaire de Saint-Etienne CHU Saint-Etienne (CHU ST-E); Physiologie & médecine expérimentale du Cœur et des Muscles U 1046 (PhyMedExp); Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS); Centre Hospitalier Régional Universitaire Montpellier (CHRU Montpellier); CHU de Grenoble-Alpes - Centre Hospitalier Universitaire CHU Grenoble (CHUGA); Laboratoire Traitement du Signal et de l'Image (LTSI); Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM); Centre Hospitalier Universitaire de Rennes CHU Rennes = Rennes University Hospital Pontchaillou; Défaillance Cardiovasculaire Aiguë et Chronique (DCAC); Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL); Service de Pneumologie CHRU Nancy; Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy); Infections Virales et Pathologie Comparée - UMR 754 (IVPC); École Pratique des Hautes Études (EPHE); Université Paris Sciences et Lettres (PSL)-Université Paris Sciences et Lettres (PSL)-Université Claude Bernard Lyon 1 (UCBL); Université de Lyon-Université de Lyon-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE); Hospices Civils de Lyon (HCL); CHU Gabriel Montpied Clermont-Ferrand; CHU Clermont-Ferrand; Facteurs de Risque et Déterminants Moléculaires des Maladies liées au Vieillissement - U 1167 (RID-AGE); Institut Pasteur de Lille; Pasteur Network (Réseau International des Instituts Pasteur)-Pasteur Network (Réseau International des Instituts Pasteur)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire CHU Lille (CHRU Lille); Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon); University of Calgary; Centre Hospitalier Universitaire de Nantes = Nantes University Hospital (CHU Nantes); Hôpital Nord Laennec CHU Nantes; Centre Hospitalier Régional Universitaire de Tours (CHRU Tours); Hôpital universitaire Robert Debré Reims (CHU Reims); American Memorial Hospital (Hôpital des enfants) Reims; Centre Hospitalier Universitaire de Nice (CHU Nice); Université Côte d'Azur (UniCA); Centre Hospitalier Universitaire Dupuytren 1 et 2 (CHU Limoges); CHU Limoges; Hôpital Haut-Lévêque CHU Bordeaux; Centre Hospitalier Universitaire de Bordeaux (CHU Bordeaux); Université de Bordeaux (UB); Centre Hospitalier Universitaire de La Réunion (CHU La Réunion); Centre Hospitalier Universitaire de Toulouse (CHU Toulouse); Hôpital de la Timone CHU - APHM (TIMONE); Assistance Publique - Hôpitaux de Marseille (APHM); Aix Marseille Université (AMU); Nouvel Hôpital Civil de Strasbourg; Hôpitaux Universitaires de Strasbourg (HUS); Centre hospitalier universitaire de Poitiers = Poitiers University Hospital (CHU de Poitiers La Milétrie ); Hôpital Européen Georges Pompidou APHP (HEGP); Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO); Clinique d'Investigation Clinique (CIC Brest); Université de Brest (UBO EPE)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hôpital de la Cavale Blanche |
| Source: |
ISSN: 1073-449X. |
| Publisher Information: |
CCSD; American Thoracic Society |
| Publication Year: |
2021 |
| Collection: |
Université Jean Monnet – Saint-Etienne: HAL |
| Subject Terms: |
therapeutics; survival; pulmonary hypertension; pulmonary arterial hypertension; [SDV]Life Sciences [q-bio] |
| Description: |
International audience ; 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, ... |
| Document Type: |
article in journal/newspaper |
| Language: |
English |
| Relation: |
info:eu-repo/semantics/altIdentifier/pmid/34185620; PUBMED: 34185620; WOS: 000705466800019 |
| DOI: |
10.1164/rccm.202009-3698OC |
| Availability: |
https://hal.science/hal-03274671; https://hal.science/hal-03274671v1/document; https://hal.science/hal-03274671v1/file/2021%20boucly%20et%20al.,%20Association%20between.pdf; https://doi.org/10.1164/rccm.202009-3698OC |
| Rights: |
https://about.hal.science/hal-authorisation-v1/ ; info:eu-repo/semantics/OpenAccess |
| Accession Number: |
edsbas.E421475 |
| Database: |
BASE |