Survival and response to pulmonary vasodilator therapies in patients with chronic obstructive pulmonary disease and pulmonary vascular phenotype.

BACKGROUND

The aim of the study was to describe and investigate the effect of pulmonary arterial hypertension (PAH) therapies in a cohort of patients with severe precapillary pulmonary hypertension (PH) associated with chronic obstructive pulmonary disease (COPD; PH-COPD), and to assess factors predictive of treatment response and mortality.

MATERIAL AND METHODS

We retrospectively included patients with severe incident PH-COPD who received PAH therapy and underwent RHC at diagnosis and on treatment.

RESULTS

From 2015 to 2022, 35 severe PH-COPD patients, with clinical features of pulmonary vascular phenotype, were included. Seventeen (48.5%) patients were treated with combined PAH therapy. PAH therapy led to a significant improvement in hemodynamics (PVR -3.5 Wood Units (-39.3%); p < 0.0001), and in the simplified four-strata risk-assessment score, which improved by at least one category in 21 (60%) patients. This effect was more pronounced in patients on dual therapy. Kaplan-Meier estimated survival rates at 1, 3 and 5 years were 94%, 65% and 42% respectively. Univariate analysis showed a significant reduction in survival in patients with a higher simplified risk score at follow-up (Hazard ratio (HR) 2.88 [1.16-7.15]; p = 0.02). Hypoxemia <50 mmHg was correlated to mortality in multivariate analysis (HR 4.33 [1.08-17.42]; p = 0.04).

CONCLUSIONS

Our study confirms the poor prognosis of patients with COPD and a pulmonary vascular phenotype and the potential interest of combined PAH therapy in this population, with good tolerability and greater clinical and hemodynamic improvement than monotherapy. Using the simplified risk score during follow-up could be of interest in this population.

Informations de copyright

Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Déclaration de conflit d'intérêts

Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Riou reports a relationship with Actelion Pharmaceuticals France SAS that includes: speaking and lecture fees. Riou reports a relationship with MSD France SAS that includes: consulting or advisory, speaking and lecture fees, and travel reimbursement. Riou reports a relationship with Laboratories Menarini France SA that includes: speaking and lecture fees. Riou reports a relationship with Boehringer Ingelheim France SAS that includes: consulting or advisory and travel reimbursement. Canuet reports a relationship with Laboratories Menarini France SA that includes: speaking and lecture fees. Canuet reports a relationship with MSD France SAS that includes: speaking and lecture fees and travel reimbursement. Enache reports a relationship with ChiesiSA France that includes: speaking and lecture fees. Enache reports a relationship with Laboratories Menarini France SA that includes: speaking and lecture fees. Martin reports a relationship with GlaxoSmithKline that includes: speaking and lecture fees. Montani reports a relationship with Acceleron Pharma that includes: consulting or advisory. Montani reports a relationship with MSD France SAS that includes: consulting or advisory and speaking and lecture fees. Montani reports a relationship with Actelion Pharmaceuticals France SAS that includes: consulting or advisory and speaking and lecture fees. Montani reports a relationship with Grupo Ferrer Internacional SA that includes: consulting or advisory. Riou reports a relationship with Grupo Ferrer Internacional SA that includes: consulting or advisory. Montani reports a relationship with Bayer Corporation that includes: speaking and lecture fees. Montani reports a relationship with Boehringer Ingelheim France SAS that includes: speaking and lecture fees. Montani reports a relationship with Chiesi Pharmaceuticals Inc that includes: speaking and lecture fees. Montani reports a relationship with GlaxoSmithKline that includes: speaking and lecture fees. Labani reports a relationship with Boehringer Ingelheim France SAS that includes: speaking and lecture fees. Kessler reports a relationship with GlaxoSmithKline that includes: speaking and lecture fees. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.