![]() Most studies at that time had examined sequential add-on strategies, in which additional agents were added only after progression of disease or lack of significant response to an initial agent these studies had mixed results. Although these agents (and others targeting different vasoactive mechanisms) showed benefits by themselves, it was unclear whether combinations of these agents would produce any additional benefits. Tadalafil, a phosphodiesterase type 5 inhibitor (PDE5i), had also been shown to increase exercise capacity in the PHIRST and PHIRST-2 trials, with benefits sustained after 68 total weeks of treatment. Ambrisentan, an endothelin receptor antagonist (ERA), was previously shown to improve exercise capacity in PAH patients in the ARIES-1 and ARIES-2 trials, with continued benefits shown over two years of treatment. Multiple vasoactive agents have been studied for use in reversing or preventing progression of these vascular changes and thereby decreasing or maintaining PVR. Increases in PVR cause increasing pressures in the right ventricle, which is particularly sensitive to afterload increases this ultimately leads to progressive cardiopulmonary failure. Pulmonary arterial hypertension (PAH, also described as WHO group I pulmonary hypertension) is a disease with a complex pathophysiology primarily mediated by pathologic changes in the pulmonary vasculature that cause increased pulmonary vascular resistance (PVR). ![]() Starting treatment with the combination of ambrisentan and tadalafil resulted in fewer clinical failure events than when either ambrisentan or tadalafil was started as a single agent. ![]() In patients with World Health Organization (WHO) functional class II or III pulmonary arterial hypertension, is it more effective to start treatment with both ambrisentan and tadalafil simultaneously, or to start treatment with only a single agent?
0 Comments
Leave a Reply. |