OBJECTIVES: Pulmonary arterial hypertension (PAH) is characterized by increased pulmonary vascular resistance that can lead to right heart failure and premature death. Two oral prostacyclin pathway drugs, oral treprostinil and selexipag, are used to treat PAH. To date there are no head-to-head studies comparing effectiveness of these two drugs. The study objective is to compare the effect of oral treprostinil to selexipag on hospitalization among PAH patients.

METHODS: A retrospective administrative claims study was conducted using the Optum Clinformatics Data Mart database to identify patients ≥ 18 years with pulmonary hypertension who were prescribed oral treprostinil or selexipag between January 1, 2015 to September 30, 2017 (index date). Patients were required to have continuous enrollment in the baseline period (≥ 6 months) prior to index date. Patients with an index drug at baseline or switched to another index drug at any time during the entire study period were excluded. Follow-up began after index date and continued until end of first drug exposure, end of continuous enrollment, all-cause death, or end of data, whichever was first. Multivariable Cox proportional hazard and Poisson regression was used to compare the effects of oral treprostinil to selexipag on PH-related hospitalization risk and rates, respectively.

RESULTS: The study population included 99 patients treated with oral treprostinil and 123 patients treated with selexipag. The study population, on average, was 61 years old and predominately female (71%). After adjusting for confounders, selexipag reduced the risk for first PH-related hospitalization by 47% compared to oral treprostinil (hazard ratio: 0.53; 95% CI (confidence interval): 0.31, 0.93; p-value: 0.03). Compared to oral treprostinil, PH-related hospitalization rate with selexipag was reduced by 46% after adjusting for confounders (rate ratio: 0.54; 95% CI: 0.35, 0.82; p-value: 0.004).

CONCLUSIONS: Selexipag is associated with lower PH-related hospitalization risk and rates compared to oral treprostinil.