04 February 2019 by Janis Pruett

Comparative Effectiveness of Oral Prostacyclin Pathway Medications on Hospitalization among Patients with PH: a Retrospective Administrative Claims Study in a US Managed Care Population


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 available 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.


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


The study population included 99 patients treated with oral treprostinil and 123 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% Confidence interval (CI) 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).


Compared to oral treprostinil, selexipag is associated with lower PH-related hospitalization risk and rates.


About the author

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Janis Pruett

Real World Value and Evidence


United States

Key Contributors

Yuen Tsang, PharmD 1, Janis Pruett, EdD, RN, MSN, FNP-BC 1, William Drake, PharmD 1 :1 Actelion Pharmaceuticals, US, Inc., South San Francisco, California, USA

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