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Title: | Patients with pulmonary arterial hypertension with and without cardiovascular risk factors: Results from the AMBITION trial |
Author: | McLaughlin, Vallerie V. Vachiéry, Jean-Luc Oudiz, Ronald J. Rosenkranz, Stephan Galiè, Nazzareno Barberà i Mir, Joan Albert Frost, Adaani E. Ghofrani, Hossein-Ardeschir Peacock, Andrew J. Simonneau, Gérald Rubin, Lewis J. Blair, Christiana Langley, Jonathan Hoeper, Marius M AMBITION Investigators |
Keywords: | Hipertensió pulmonar Avaluació del risc per la salut Malalties cardiovasculars Pulmonary hypertension Health risk assessment Cardiovascular diseases |
Issue Date: | 1-Dec-2019 |
Publisher: | Elsevier |
Abstract: | Background: The purpose of this study was to compare patients with pulmonary arterial hypertension enrolled in the AMBITION trial with (excluded from the primary analysis set [ex-primary analysis set]) and without (primary analysis set) multiple risk factors for left ventricular diastolic dysfunction. Methods: Treatment-naive patients with pulmonary arterial hypertension were randomized to once-daily ambrisentan and tadalafil combination therapy, ambrisentan monotherapy, or tadalafil monotherapy. The primary end point was time from randomization to first adjudicated clinical failure event. Results: Primary analysis set patients (n = 500), compared with ex-primary analysis set patients (n = 105), were younger (mean, 54.4 vs 62.1 years) with greater baseline 6-minute walk distance (median, 363.7 vs 330.5 meters) and fewer comorbidities (e.g., hypertension and diabetes). Treatment effects of initial combination therapy vs pooled monotherapy were directionally the same for both populations, albeit of a lower magnitude for ex-primary analysis set patients. Initial combination therapy reduced the risk of clinical failure compared with pooled monotherapy in primary analysis set patients (hazard ratio, 0.50; 95% confidence interval, 0.35-0.72), whereas the effect was less clear in ex-primary analysis set patients (hazard ratio, 0.70; 95% confidence interval, 0.35-1.37). Overall, primary analysis set patients had fewer clinical failure events (25% vs 33%), higher rates of satisfactory clinical response (34% vs 24%), and lower rates of permanent study drug withdrawal due to adverse events (16% vs 31%) than ex-primary analysis set patients. Conclusions: Efficacy of initial combination therapy vs pooled monotherapy was directionally similar for primary analysis set and ex-primary analysis set patients. However, ex-primary analysis set patients (with multiple risk factors for left ventricular diastolic dysfunction) experienced higher rates of clinical failure events and the response to combination therapy vs monotherapy was attenuated. Tolerability was better in primary analysis set than ex-primary analysis set patients. |
Note: | Reproducció del document publicat a: https://doi.org/10.1016/j.healun.2019.09.010 |
It is part of: | Journal of Heart and Lung Transplantation, 2019, vol. 38, num. 12, p. 1286-1295 |
URI: | http://hdl.handle.net/2445/183367 |
Related resource: | https://doi.org/10.1016/j.healun.2019.09.010 |
ISSN: | 1053-2498 |
Appears in Collections: | Articles publicats en revistes (Medicina) Articles publicats en revistes (IDIBAPS: Institut d'investigacions Biomèdiques August Pi i Sunyer) |
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