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Choice of Initial Oral Therapy for Pulmonary Arterial Hypertension, Age and Long-Term Survival: A Propensity Score Analysis

Heresi Davila, Gustavo Adolfo
http://rave.ohiolink.edu/etdc/view?acc_num=case1491430607305639

Abstract Details

2017, Master of Sciences, Case Western Reserve University, Clinical Research.
Background Oral mono or combination therapy is recommended for patients with low or intermediate risk pulmonary arterial hypertension (PAH), but the specific drug choice remains controversial. We aim to assess long-term survival in PAH patients treated initially with a phosphodiesterase-5 inhibitor (PDE5i) or an endothelin receptor blocker (ERA). We also sought to identify responders to a specific type of drug. Methods Retrospective cohort study conducted at the Cleveland Clinic in group 1 PAH. Primary outcome was all-cause mortality according to initial treatment exposure. We adjusted for imbalances in baseline covariates via propensity score matching and weighting. Results The study population consisted of 91 patients treated with an ERA and 146 with a PDE5i (age 54 16 and 57 15 years, females 82% and 62%, respectively) between 2001 and 2015. Median follow up was 1304 days (interquartile range 606, 2058). There was no difference in survival after propensity score matching (HR 1.18 [95% CI 0.62, 2.25) or weighting (HR 0.88, [95% CI 0.48, 1.61]). There was a significant interaction between treatment and age (p = 0.002). The relative hazard ratio of death was lower with ERA therapy in patients younger than 45 years of age, and higher in patients older than 65 years of age. Conclusions After adjusting for baseline covariates, long-term survival was similar with initial treatment with an ERA or a PDE5i. However, younger patients had better survival when treated with an ERA, while the elderly survived longer with a PDE5i.
Thomas Love (Committee Chair)
Raed Dweik (Committee Member)
James Spilsbury (Committee Member)
56 p.
Health Care; Medicine; Therapy
pulmonary arterial hypertension; survival; age; treatment

Recommended Citations

Citations

  • Heresi Davila, G. A. (2017). Choice of Initial Oral Therapy for Pulmonary Arterial Hypertension, Age and Long-Term Survival: A Propensity Score Analysis [Master's thesis, Case Western Reserve University]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=case1491430607305639

    APA Style (7th edition)

  • Heresi Davila, Gustavo. Choice of Initial Oral Therapy for Pulmonary Arterial Hypertension, Age and Long-Term Survival: A Propensity Score Analysis . 2017. Case Western Reserve University, Master's thesis. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=case1491430607305639.

    MLA Style (8th edition)

  • Heresi Davila, Gustavo. "Choice of Initial Oral Therapy for Pulmonary Arterial Hypertension, Age and Long-Term Survival: A Propensity Score Analysis ." Master's thesis, Case Western Reserve University, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=case1491430607305639

    Chicago Manual of Style (17th edition)

case1491430607305639
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© 2017, all rights reserved.
This open access ETD is published by Case Western Reserve University School of Graduate Studies and OhioLINK.