Journal article
Authors list: Hoeper, Marius M.; Pausch, Christine; Olsson, Karen M.; Huscher, Doerte; Pittrow, David; Gruenig, Ekkehard; Staehler, Gerd; Vizza, Carmine Dario; Gall, Henning; Distler, Oliver; Opitz, Christian; Gibbs, J. Simon R.; Delcroix, Marion; Ghofrani, H. Ardeschir; Ewert, Ralf; Kaemmerer, Harald; Kabitz, Hans-Joachim; Skowasch, Dirk; Behr, Juergen; Milger, Katrin; Halank, Michael; Wilkens, Heinrike; Seyfarth, Hans-Juergen; Held, Matthias; Dumitrescu, Daniel; Tsangaris, Iraklis; Vonk-Noordegraaf, Anton; Ulrich, Silvia; Klose, Hans; Claussen, Martin; Eisenmann, Stephan; Schmidt, Kai-Helge; Rosenkranz, Stephan; Lange, Tobias J.
Publication year: 2022
Pages: 971-981
Journal: The Journal of Heart and Lung Transplantation
Volume number: 41
Issue number: 7
ISSN: 1053-2498
eISSN: 1557-3117
DOI Link: https://doi.org/10.1016/j.healun.2022.03.011
Publisher: Elsevier
BACKGROUND: The prognostic value of improvement endpoints that have been used in clinical trials of treatments for pulmonary arterial hypertension (PAH) needs to be further investigated. METHODS: Using the COMPERA database, we evaluated the prognostic value of improvements in functional class (FC) and absolute or relative improvements in 6-min walking distance (6MWD) and N-terminal fragment of pro-brain natriuretic peptide (NT-proBNP). In addition, we investigated multicomponent endpoints based on prespecified improvements in FC, 6MWD and NT-proBNP that have been used in recent PAH trials. Finally, we assessed the predictive value of improvements determined by risk stratification tools. The effects of changes from baseline to first follow-up (3-12 months after initiation of PAH therapy) on consecutive survival were determined by Kaplan-Meier analysis with Log-Rank testing and Cox proportional hazard analyses. RESULTS: All analyses were based on 596 patients with newly diagnosed PAH for whom complete data were available at baseline and first follow-up. Improvements in FC were associated with improved survival, whereas absolute or relative improvements in 6MWD had no predictive value. For NT-proBNP, absolute declines conferred no prognostic information while relative declines by >= 35% were associated with better survival. Improvements in multicomponent endpoints were associated with improved survival and the same was found for risk stratification tools. CONCLUSION: While sole improvements in 6MWD and NT-proBNP had minor prognostic relevance, improvements in multicomponent endpoints and risk stratification tools based on FC, 6MWD, and NT-proBNP were associated with improved survival. These tools should be further explored as outcome measures in PAH trials. (C) 2022 The Author(s). Published by Elsevier Inc. on behalf of International Society for Heart and Lung Transplantation.
Abstract:
Citation Styles
Harvard Citation style: Hoeper, M., Pausch, C., Olsson, K., Huscher, D., Pittrow, D., Gruenig, E., et al. (2022) Prognostic value of improvement endpoints in pulmonary arterial hypertension trials: A COMPERA analysis, The Journal of Heart and Lung Transplantation, 41(7), pp. 971-981. https://doi.org/10.1016/j.healun.2022.03.011
APA Citation style: Hoeper, M., Pausch, C., Olsson, K., Huscher, D., Pittrow, D., Gruenig, E., Staehler, G., Vizza, C., Gall, H., Distler, O., Opitz, C., Gibbs, J., Delcroix, M., Ghofrani, H., Ewert, R., Kaemmerer, H., Kabitz, H., Skowasch, D., Behr, J., ...Lange, T. (2022). Prognostic value of improvement endpoints in pulmonary arterial hypertension trials: A COMPERA analysis. The Journal of Heart and Lung Transplantation. 41(7), 971-981. https://doi.org/10.1016/j.healun.2022.03.011
Keywords
AMBRISENTAN; BOSENTAN; Clinical trials; endpoints; morbidity; pulmonary arterial hypertension; RIOCIGUAT; RISK SCORE; TADALAFIL; WALK DISTANCE
