Selexipag Benefit Based on Time of Diagnosis

How new GRIPHON data showed further definitive long-term outcomes for patients with pulmonary hypertension.

New post hoc analyses from the large-scale GRIPHON trial assessing selexipag (UPTRAVI) in patients with pulmonary arterial hypertension (PAH) show that early, aggressive treatment of the uncommon pulmonary disease post-diagnosis is associated with the greatest benefits.

The data, presented at the American Thoracic Society (ATS) 2019 International Meeting in Dallas, TX, showed that all observed background PAH therapy subgroups involved in the 2015 trial had benefitted more greatly from selexipag the sooner from when they were first diagnosed.

The findings are something of a relief for specialists Rich Channick, MD, director of the Acute and Thromboembolic Disease Program at the UCLA Medical Center, and Prof. Sean Gaine, Director of the National Pulmonary Hypertension Unit in Ireland. In an interview with MD Magazine® at ATS, the pair explained why the practice for PAH care has been prompt even before the new GRIPHON data.

MD Mag: What are the newest findings from the GRIPHON study?

Gaine: So the GRIPHON study, by way of introduction, was the largest randomized, controlled trial event-driven in the area of pulmonary hypertension. There were 1156 patients in the trial. And it was published in the New England Journal of Medicine back in 2015.

And we're still looking at the data. It's such a huge data set. We've been looking at the data and diving into it, seeing what messages there are in there beyond the first paper that came out. At the meeting here, we've presented some new data, looking at patients who had the disease for a short period of time—less than 6 months—and looking at patients who had the disease for a longer period of time—longer than 6 months. We just wanted to see what effect the drug had on the primary endpoint in those 2 groups.

We presented that today showing, in fact, the drug works in both groups, but there's a more pronounced effect in patients who were treated earlier in their disease.

Channick: For your audience who may not know a lot about this disease, this is very life-threatening. It often strikes younger people. Without treatment, survival is 2-3 years on average.

We now have many effective treatments. UPTRAVI, which is what the GRIPHON trial looked at, works through a pathway called the prostacyclin pathway. And the way we treat this disease now is through a few different targets.

I think this latest study really adds to what we already feel we need to do with these patients: treating them early and treating them aggressively. It's nice to see this study underline that point.

The study, "The Impact of Time from Diagnosis at Baseline on Long-Term Outcome in the GRIPHON Study: Selexipag in Pulmonary Arterial Hypertension," was presented at ATS 2019.