Poster No. 115 Switch the risk: from PDE5i to Riociguat in real world pulmonary hypertension

Abstract

Introduction: Switching from phosphodiesterase-5 inhibitors (PDE5i) to Riociguat is associated with increased efficacy in pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH). Objective: To show clinical efficacy of replacing PDE5i to Riociguat in a portuguese PH-dedicated centre. Methods: Retrospective single-centre study of PAH and inoperable/persistent/recurrent CTEPH patients (pts) who switched vasodilator therapy. Parameters were stratified according to the 2022 PH guidelines and stratification as low/intermediate/high-risk PH followed the COMPERA registry, before switching, at 3-6 months of follow-up (FUP) and until the last clinical evaluation, balloon pulmonary angioplasty (BPA), heart transplant or death. Results: Of 13 pts, 75.0% had CTEPH (4 pts had persistent disease after surgical endarterectomy), 16.7% had PAH and 1pt had mixed PAH/ CTEPH. Mean age was 56.2± 16.3years and 83.3% were females. Mean time until switch was 33.5±25.5 months. Previous therapy was: 33.3% Sildenafil, 41.7% Sildenafil/Bosentan and 25% Sildenafil/Bosentan/prostanoid. Before switching, 66.7% had intermediate and 33.3% low-risk PH; at a FUP of 4.4±1.7 months, 8.3% had intermediate and 91.7% low-risk PH. There was a significant benefit in the COMPERA risk (1.50[1.33;1.62] vs. 1.22[1.09;1.40], P=0.011). Long-term FUP was performed in 8 pts at 48.2±35.6 months (death 1pt, transplant 1pt, BPA 3 pts). Medical treatment was Riociguat in 33.3%, Riociguat and Bosentan in 58.3%, and 1pt with Riociguat, Bosentan and Treprostinil. Clinical benefit was significant at long-term FUP when compared to the initial evaluation (1.22[1.09;1.40], P=0.011), but not to the first FUP. Conclusion: This study corroborates previous evidence regarding the vasodilator switch and also suggests that the treatment goal is maintained throughout long-term FUP.