Guidelines Updated for Pulmonary Arterial Hypertension in Adults
New evidence led to development of two new recommendations for combination therapy
WEDNESDAY, Feb. 13, 2019 (Pharmacist's Briefing) -- In the latest evidence-based guideline from the American College of Chest Physicians, published online Jan. 17 in CHEST, updated recommendations are provided for the management of adults with pulmonary arterial hypertension (PAH).
James R. Klinger, M.D., from Brown University in Providence, Rhode Island, and colleagues conducted a systematic review to identify studies published after the 2014 guideline. The quality of evidence was assessed for each critical or important outcome of interest.
The authors developed two new recommendations on combination therapy and two ungraded consensus-based statements on palliative care. The recommendations about pharmacologic therapy comprised a suggestion for initial combination therapy with ambrisentan and tadalafil to improve six-minute walk distance (6MWD) for treatment-naive PAH patients with World Health Organization functional class II and III. Tadalafil should be added to improve 6MWD for stable or symptomatic patients with PAH on background therapy with ambrisentan. The consensus-based statements suggest incorporating palliative care services for patient management and participation in supervised exercise activity as part of integrated care. In addition, an evidence-based and consensus-driven treatment algorithm was created for physicians to guide management.
"This document provides an evidence-based update addressing important developments in the utilization of combination therapy, and consensus-based suggestions on the integration of palliative care and exercise training (cardiopulmonary rehabilitation) into overall disease management," the authors write. "We continue to suggest early referral to expert centers and collaborative care using sound clinical judgment."