Raymond L Benza1, Harrison W Farber2, Adaani E Frost3, Hossein-Ardeschir Ghofrani4, Paul A Corris5, Marc Lambelet6, Sylvia Nikkho7, Christian Meier8, Marius M Hoeper9. 1. Department of Medicine, Ohio State University Wexner Medical Center, Columbus, OH, USA. Electronic address: Raymond.Benza@osumc.edu. 2. Pulmonary Hypertension Center, Boston University/Boston Medical Center, Boston, MA, USA. 3. Department of Medicine, Research Institute and Institute of Academic Medicine, Houston Methodist, Houston, TX, USA. 4. University of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), Giessen, Germany; Department of Medicine, Imperial College London, London, UK; Department of Pneumology, Kerckhoff-Klinik, Bad Nauheim, Germany. 5. Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK. 6. CHRESTOS Concept GmbH & Co. KG, Essen, Germany. 7. Global Clinical Development, Bayer AG, Berlin, Germany. 8. Global Medical Affairs, Bayer AG, Berlin, Germany. 9. Clinic for Respiratory Medicine, Hannover Medical School, Member of the German Center for Lung Research (DZL), Hannover, Germany.
Abstract
BACKGROUND: Regular risk assessment is recommended in pulmonary arterial hypertension (PAH) management to improve patient outcomes. The REVEAL risk score (RRS) predicts survival in patients with PAH, including those from the PATENT study, which assessed riociguat, a soluble guanylate cyclase stimulator approved for PAH treatment. An updated version, RRS 2.0, has been developed to further refine risk prediction. METHODS: This post hoc analysis of PATENT-1 and its open-label extension PATENT-2 (n = 396) assessed RRS 2.0 score and risk stratum and their association with survival and clinical worsening-free survival (CWFS). RESULTS: At PATENT-1 Week 12, riociguat improved RRS 2.0 versus placebo (least-squares mean difference versus placebo: -1.0 [95% confidence interval - 1.4 to -0.6; p < 0.0001]) and more patients improved risk stratum with riociguat (57%) versus placebo (42%). These improvements were maintained at PATENT-2 Week 12. RRS 2.0 score and risk strata at PATENT-1 baseline and Week 12 were significantly associated with survival and CWFS in PATENT-2 (p < 0.0001); change in RRS 2.0 score from PATENT-1 baseline to Week 12 was also significantly associated with outcomes. CONCLUSIONS: These data suggest that RRS 2.0 has clinical utility in predicting long-term outcomes and monitoring treatment response in patients with PAH.
BACKGROUND: Regular risk assessment is recommended in pulmonary arterial hypertension (PAH) management to improve patient outcomes. The REVEAL risk score (RRS) predicts survival in patients with PAH, including those from the PATENT study, which assessed riociguat, a soluble guanylate cyclase stimulator approved for PAH treatment. An updated version, RRS 2.0, has been developed to further refine risk prediction. METHODS: This post hoc analysis of PATENT-1 and its open-label extension PATENT-2 (n = 396) assessed RRS 2.0 score and risk stratum and their association with survival and clinical worsening-free survival (CWFS). RESULTS: At PATENT-1 Week 12, riociguat improved RRS 2.0 versus placebo (least-squares mean difference versus placebo: -1.0 [95% confidence interval - 1.4 to -0.6; p < 0.0001]) and more patients improved risk stratum with riociguat (57%) versus placebo (42%). These improvements were maintained at PATENT-2 Week 12. RRS 2.0 score and risk strata at PATENT-1 baseline and Week 12 were significantly associated with survival and CWFS in PATENT-2 (p < 0.0001); change in RRS 2.0 score from PATENT-1 baseline to Week 12 was also significantly associated with outcomes. CONCLUSIONS: These data suggest that RRS 2.0 has clinical utility in predicting long-term outcomes and monitoring treatment response in patients with PAH.
Authors: Julie Coursen; Catherine E Simpson; Monica Mukherjee; Arthur J Vaught; Shelby Kutty; Tala K Al-Talib; Malissa J Wood; Nandita S Scott; Stephen C Mathai; Garima Sharma Journal: J Cardiovasc Dev Dis Date: 2022-08-11