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Hypertension

Initial combination therapy improves PAH

Nature Reviews Cardiology volume 12, page 623 (2015)Cite this article

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The efficacy of initial combination therapy for the treatment of pulmonary arterial hypertension (PAH) is unknown, but previous reports have shown that combination therapy with drugs that target different mechanistic pathways might improve clinical outcomes. Investigators in the AMBITION trial sought to assess the efficacy and safety of initial combination therapy with the endothelin receptor antagonist ambrisentan and the phosphodiesterase type 5 inhibitor tadalafil in previously untreated individuals with PAH, and their findings have now been published in The New England Journal of Medicine.

In this multicentre, randomized, double-blind trial, patients with PAH who had not been treated with an approved therapy were randomly assigned to receive 10 mg of ambrisentan plus 40 mg of tadalafil (combination-therapy group), 10 mg of ambrisentan plus placebo (ambrisentan-monotherapy group), or 40 mg of tadalafil plus placebo (tadalafil-monotherapy group) in a 2:1:1 ratio. The primary end point was the first incident of clinical failure, defined as a composite end point of death from any cause, hospitalization for PAH, progression of disease, or unsatisfactory long-term clinical response. Disease progression and clinical response were based on measures of changes in baseline 6-min walking distance in combination with WHO functional class III or IV symptoms.

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References

  1. Galiè, N. et al. Initial use of ambrisentan plus tadalafil in pulmonary arterial hypertension. N. Engl. J. Med. 373, 834–844 (2015)

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  1. Karina Huynh
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Huynh, K. Initial combination therapy improves PAH. Nat Rev Cardiol 12, 623 (2015). https://doi.org/10.1038/nrcardio.2015.144

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