Persistence with macitentan versus other endothelin receptor antagonists in patients with pulmonary arterial hypertension: experience from a real-world data repository in the USA

Abstract Background Pulmonary arterial hypertension (PAH) is a progressive and fatal disease as such, it imperative that patients remain on therapy to delay progression maintain functional status. Previous research has demonstrated differences in overall survival the real-world by endothelin receptor antagonists (ERA) treatments with lower risk of death macitentan than ambrisentan bosentan. However, data persistence ERAs are limited. Purpose To compare versus bosentan) PAH. Methods This retrospective, non-interventional, observational study identified between 10/21/2013–3/31/2021 (study period) from Decision Resources Group (DRG) Real World Data Repository. The repository links medical prescription claims commercial, Medicaid, Medicare plans electronic health records (EHRs) provide longitudinal patient-level representative over 300 million US. Patients selected must have been dispensed an ERA 4/14/14–3/31/20 AND 1) either inpatient diagnosis pulmonary (PH), or 2) right heart catheterization any PH diagnosis, 3) were taking phosphodiesterase 5 inhibitor (PDE5i). primary outcome was defined time index drug discontinuation (90-day gap after end last prescription's days supply). Descriptive analysis comprised means, standard deviations, medians, interquartile ranges for continuous variables frequencies percentages categorical variables. Three-sample proportion tests conducted at baseline detect three cohorts identify potentially confounding Hazard ratios (HR) pairwise comparisons (macitentan vs ambrisentan; calculated using inverse probability treatment weighting (IPTW)-adjusted Cox proportional regression model, adjust potential confounders (see Table receiving specific ERA. analyzed Kaplan-Meier method. Results A total 4,526 included, whom 1,205 received macitentan, 2,592 729 Study population characteristics general PAH (Table 1). Unadjusted showed median shortest (12.6 months) followed bosentan (13.6 greatest (15.8 months; log-rank p-value: 0.061). Compared other had greater discontinuation: (10%) (18%) 2). Conclusions Persistence significantly macitentan-treated those Further examining variability key sub-groups well impact improved long-term outcomes warranted. Funding Acknowledgement Type funding sources: Private company. Main source(s): Janssen Scientific Affairs, LLC