CHEST Guidelines-Results-of-an-Expert-Consensus-Survey-on-the-Treat

Results-of-an-Expert-Consensus-Survey-on-the-Treat

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The document outlines the findings of an expert consensus survey concerning the use of oral prostacyclin pathway agents (PPAs) in treating pulmonary arterial hypertension (PAH), specifically treprostinil and selexipag. Given the variability in treatment options for PAH based on etiology and patient symptoms, the lack of definitive guidelines spurred the need for expert consensus.<br /><br />The panel, composed of specialists in cardiovascular and pulmonary medicine, aimed to formulate guidance statements for initiating oral PPAs in adults with PAH. A systematic literature review and the RAND/University of California Los Angeles appropriateness method were used to create 14 consensus statements. These statements specifically address whether oral PPAs should be used in patients with idiopathic, heritable, repaired congenital heart defect, drug- or toxin-induced PAH (collectively termed IPAH+), or connective tissue disease-associated PAH.<br /><br />The survey results indicate that selexipag might be suitable for consideration in certain patients with IPAH+ or connective tissue disease-associated PAH and either low- or intermediate-risk hemodynamics, depending on factors such as hospitalization history and right ventricular (RV) function. However, it was generally deemed inappropriate to recommend oral treprostinil as the evidence from clinical trials at the time did not support its efficacy in combination with other therapies.<br /><br />The consensus statements are meant to guide physicians in clinical decision-making under scenarios where clinical evidence is scarce. Nonetheless, these statements cannot supplant personalized clinical assessments by healthcare professionals, who must also consider patient-specific factors like comorbidities and preferences.<br /><br />Ultimately, while this expert consensus provides a baseline for decision-making in PAH management with oral PPAs, further clinical trials and studies are needed to fill the existing gaps in definitive evidence, particularly concerning oral treprostinil.

Keywords

pulmonary arterial hypertension

oral prostacyclin pathway agents

treprostinil

selexipag

expert consensus

guidance statements

IPAH+

connective tissue disease-associated PAH

clinical decision-making

clinical trials