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Predictors of long-term outcomes in patients treated with riociguat for pulmonary arterial hypertension: Data from the PATENT-2 open-label, randomised, long-term extension trial

Citation

Ghofrani, H-A and Grimminger, F and Grunig, E and Huang, Y and Jansa, P and Jing, Z-C and Kilpatrick, D and Langleben, D and Rosenkranz, S and Menezes, F and Fritsch, A and Nikkho, S and Humbert, M, Predictors of long-term outcomes in patients treated with riociguat for pulmonary arterial hypertension: Data from the PATENT-2 open-label, randomised, long-term extension trial, The Lancet Respiratory Medicine, 4, (5) pp. 361-371. ISSN 2213-2600 (2016) [Refereed Article]

Copyright Statement

Copyright 2017 Elsevier Inc.

DOI: doi:10.1016/S2213-2600(16)30019-4

Abstract

Background: Pulmonary arterial hypertension is a chronic disease associated with poor long-term outcomes. Identifying predictors of long-term outcome in pulmonary arterial hypertension is important to assess disease severity and guide treatment. We investigate associations between efficacy parameters and long-term outcomes in patients with pulmonary arterial hypertension receiving riociguat in the PATENT-2 study. We also present safety and efficacy data from the final data cutoff of PATENT-2, where most patients had received at least 2 years of riociguat treatment.

Methods: Eligible patients from the PATENT-1 study entered the PATENT-2 open-label extension, which will continue until all patients transition to the commercial drug. All patients received riociguat individually adjusted to a maximum dose of 25 mg three times a day. The primary endpoint was safety and tolerability, assessed with recording adverse events, serious adverse events, discontinuations, and deaths; exploratory assessments included 6-min walking distance (6MWD), WHO functional class, N-terminal prohormone of brain natriuretic peptide (NT-proBNP)concentrations, Borg dyspnoea score, health-related quality of life (EQ-5D score), survival, and clinical worsening-free survival. Association between efficacy parameters and long-term outcomes was assessed using Kaplan-Meier analyses and a Cox proportional-hazards regression model. PATENT-2 is registered at ClinicalTrials.gov, number NCT00863681.

Findings: 396 patients entered PATENT-2, of whom 197 patients were receiving riociguat monotherapy and 199 were receiving riociguat in combination with endothelin receptor antagonists or prostanoids, or both. A significant association was noted between 6MWD, NT-proBNP concentration, and WHO functional class and overall survival at baseline (p=00006, 00225, and 00191, respectively), and at follow-up (p=0021, 00056, and 00048, respectively). Riociguat was well tolerated in PATENT-2. Serious adverse events were recorded in 238 (60%) of the total population, and 45 (11%) patients discontinued treatment because of an adverse event. Improvements in 6MWD, WHO functional class, and NT-proBNP concentrations were maintained after 2 years of treatment.

Interpretation: These results support the long-term use of riociguat in patients with pulmonary arterial hypertension, and emphasise the prognostic value of 6MWD, WHO functional class, and NT-proBNP concentrations.

Item Details

Item Type:Refereed Article
Research Division:Medical and Health Sciences
Research Group:Cardiorespiratory Medicine and Haematology
Research Field:Cardiology (incl. Cardiovascular Diseases)
Objective Division:Health
Objective Group:Clinical Health (Organs, Diseases and Abnormal Conditions)
Objective Field:Cardiovascular System and Diseases
Author:Kilpatrick, D (Professor David Kilpatrick)
ID Code:117127
Year Published:2016
Web of Science® Times Cited:22
Deposited By:Medicine (Discipline)
Deposited On:2017-06-01
Last Modified:2017-11-03
Downloads:0

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