Real-world analysis on hemodynamic effectiveness and adverse events of selexipag in pulmonary arterial hypertension
Ryotaro Asano, Takatoyo Kiko, Takanori Kawabata, Yuka Sano, Hiroyuki Endo, Ryo Takano, Shinya Fujisaki, Hiroya Hayashi, Jin Ueda, Akihiro Tsuji, Koichi Matsuoka, Kohji Murakami, Takeshi OgoBackground
Selexipag, an oral IP prostacyclin receptor agonist, improves outcomes in pulmonary arterial hypertension (PAH); however, real-world hemodynamic data and the relationship between adverse events (AEs) and treatment response are limited.
Objectives
The aims of this study were to evaluate the efficacy and safety of selexipag in a Japanese cohort and assess whether treatment-emergent adverse events, particularly headache and diarrhea, were associated with subsequent hemodynamic responses.
Design
We conducted a retrospective observational study at the National Cerebral and Cardiovascular Center in Japan.
Methods
We retrospectively analyzed consecutive patients with PAH initiating selexipag at our institution between 2016 and 2022. Baseline and follow-up right heart catheterization, 6-minute walk distance (6MWD), and B-type natriuretic peptide (BNP) were assessed at 26, 52, and 104 weeks. AEs requiring treatment were recorded.
Results
Of the 97 included patients, 94% received dual or triple PAH therapies at baseline. At 52 weeks, selexipag was associated with reductions in pulmonary vascular resistance (−1.36±4.70 Wood units;
Conclusion
Selexipag initiation improved pulmonary hemodynamics, exercise capacity, and risk profile, without new safety signals. Headache, a common prostacyclin-related AE, may indicate treatment responsiveness and predict therapeutic outcomes. Careful titration to the maximally tolerated dose with vigilant AE management may optimize outcomes.