Confronto tra triplice farmacoterapia orale e parenterale nell'ipertensione arteriosa polmonare

Conclusions: This study confirmed the clinical and functional benefits of using prostacyclin analogues and prostacyclin receptor agonists in improving functional class, distance covered in the six-minute walk test, and cardiopulmonary haemodynamics. Furthermore, although selexipag appears to be the least effective drug, epoprostenol the most effective and treprostinil intermediate, it is important to note that the three drugs were prescribed to three different types of patients and, in relation to the different baseline risk, satisfactory results were obtained with all three types of therapy. Purpose: The aim of this study was to re-evaluate our experience with the use of drugs that interact with the prostacyclin pathway, comparing the clinical and haemodynamic efficacy. Background: Specific pharmacotherapy for the treatment of pulmonary arterial hypertension targets three different cellular signalling pathways: the nitric oxide pathway, the endothelin pathway and the prostacyclin pathway. Materials and methods: The study retrospectively included all patients who started therapy with epoprostenol, treprostinil or selexipag and who were referred to our centre between February 1995 and December 2024. For each inclusion in the study, invasive and non-invasive parameters were collected both at baseline, corresponding to the date of right heart catheterisation prior to the start of prostanoid therapy, and at the follow-up assessment, performed 3-4 months after the start of specific drug therapy. Results: Initially, 361 patients were enrolled in the study, of whom 23 were excluded due to the absence of haemodynamic parameters at baseline assessment: 15 had started therapy at another centre, while for the remaining 8, a non-invasive follow-up strategy was chosen. We chose not to include those who had started prostacyclin as first- or second-line therapy in order to bring the study into line with current guidelines.