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• W2895761412 abstract "SESSION TITLE: Pharmacologic Agents in Pulmonary Hypertension SESSION TYPE: Original Investigations PRESENTED ON: 10/07/2018 07:30 AM - 08:30 AM PURPOSE: Initiation of prostacyclin agents for the treatment of pulmonary arterial hypertension (PAH) typically require titration to the patient’s highest tolerated dose (HTD). Uptravi® (selexipag) is an oral, selective IP prostacyclin receptor agonist indicated for the treatment of PAH. In the event-driven, long-term GRIPHON trial, selexipag significantly reduced the risk of morbidity/mortality events compared with placebo. In GRIPHON, patients were titrated in 200mcg increments, usually on a weekly basis, to their HTD up to 1600mcg twice daily (BID). Titration and dosing trends remain to be seen in real-world practice. METHODS: Data were analyzed retrospectively from dosing and shipment records from specialty pharmacies (SPs). Patients were included if they had at least 6 months of exposure to selexipag and 6 shipments. The time point of 6 months was selected as patients were likely to have finished titration and have reached their maintenance dose. Maintenance dose was reached when the dose shipped was consistent with BID dosing at the reported strength and for the full length of shipment. For example, if patients were reported at 600mcg BID then the drug shipment quantity and strength needed to match the day supply (30 days, 7 days, etc). All other shipments were considered titration. As in GRIPHON, doses were grouped into low (200 and 400mcg), medium (600, 800, and 1000mcg), and high (1200, 1400, and 1600mcg) BID groups. RESULTS: At the time of this analysis, 2490 patients were exposed to selexipag for at least 6 months and had corresponding shipment data. At the time of the first maintenance shipment, 15.6%, 33.9%, and 50.5% of patients were receiving doses in the low, medium, and high dose groups, respectively. The overall median time to reach maintenance dose was 83 days. The time to reach maintenance dose did not appear to correlate with the dose reached. Additionally, when comparing the dose at the first maintenance shipment with last available shipment, 64% of patients were on the same dose while 36% were on a different dose. Of those on different doses, 50% had decreases while 50% had increases in their dose. CONCLUSIONS: This is the first report of selexipag dosing using real-world data from SPs. More patients reached doses in the high dose group. This is similar to GRIPHON, in which 23%, 31%, and 43% of patients reached maintenance doses in the low, medium, and high dose groups; the effect of selexipag was consistent across these dose groups. CLINICAL IMPLICATIONS: The median time to reach maintenance dose suggests that clinicians may be titrating selexipag slower than on a weekly basis. Additional analyses are required to assess the impact of a slower titration phase on a patient’s HTD and persistence on therapy. DISCLOSURES: no disclosure on file for Christine Archer-Chicko; Employee relationship with Actelion Please note: >$100000 Added 02/09/2018 by Tiffany Kung, source=Web Response, value=Salary Advisory Committee Member relationship with Actelion/Janssen Please note: $5001 - $20000 Added 03/02/2018 by Harold Palevsky, source=Web Response, value=Honoraria Advisory Committee Member relationship with United Therapeutics Please note: $1001 - $5000 Added 03/02/2018 by Harold Palevsky, source=Web Response, value=Honoraria DSMB relationship with Eiger Please note: $5001 - $20000 Added 03/02/2018 by Harold Palevsky, source=Web Response, value=Honoraria Employee relationship with Actelion Pharmaceuticals Please note: >$100000 Added 03/16/2018 by Susan Raspa, source=Web Response, value=Salary" @default.
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• W2895761412 date "2018-10-01" @default.
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• W2895761412 title "DOSING TRENDS FOR UPTRAVI (SELEXIPAG) IN REAL-WORLD PRACTICE: A REVIEW OF SPECIALTY PHARMACY DATA" @default.
• W2895761412 doi "https://doi.org/10.1016/j.chest.2018.08.917" @default.
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