Plan from the start to add UPTRAVI® within 6 months of diagnosis with pulmonary arterial hypertension (PAH), if the patient is not fully at low risk on dual therapy.[1][2][3][4]
According to the 2022 European Society of Cardiology (ESC)/European Respiratory Society (ERS) guidelines, the overall treatment goal in patients with pulmonary arterial hypertension (PAH) is to achieve and/or maintain a low-risk status,[1] which is associated with improved overall survival and functional capacity in patients.[5] Regular multiparameter risk assessment is recommended to evaluate patient risk status.[1]
Adapted from Humbert et al. 2022[1]
Treatment with a prostacyclin receptor agonist allows for targeted treatment in PAH patients at risk of disease progression before initiation of parenteral therapy.[1][6] The 2022 ESC/ERS guidelines recommend that selexipag (UPTRAVI®) may be considered for patients on dual therapy who are at intermediate–high risk when the addition of IV/SC prostacyclin analogues is unfeasible.[1]
Learn about the patient profiles identified as benefiting from UPTRAVI® initiation.[3]
UPTRAVI® relaxes and widens the blood vessels by acting as an agonist at the prostacyclin (IP) receptors on the cellular surface. The density of these IP receptors is different amongst patients:[7]
Variations in IP receptor density from patient to patient can help explain the importance of an individualised maintenance dose for each patient.[7] Over the course of weeks, the dose of UPTRAVI® is gradually titrated, allowing the patient’s body to adjust to the new medication.[8]
The recommended starting dose is 200 mcg twice daily. Tolerability may be improved when taken with food. Increase by 200 mcg twice daily, usually at weekly intervals, to the highest tolerated dose, up to 1600 mcg twice daily. If the dose is not tolerated, reduce to the previous tolerated dose.[8]
If a dose of UPTRAVI® is missed, patients should take the missed dose as soon as possible unless the next dose is within the next 6 hours. If treatment is missed for 3 days or more, restart UPTRAVI® at a lower dose and then retitrate.[8]
In the GRIPHON trial, UPTRAVI® delivered consistent efficacy across individualised maintenance dose groups, reducing the risk of disease progression vs placebo in patients with pulmonary arterial hypertension (PAH) receiving twice-daily (BID) low-, medium- and high-dose treatment.*[11]
Adapted from Sitbon et al. 2015[11]
*Low-dose group (HR 0.60; 95% CI: 0.41–0.88), medium-dose group (HR 0.53; 95% CI: 0.38–0.72), high-dose group (HR 0.64; 95% CI: 0.49–0.82).[11]
‡Composite primary endpoint; results do not apply to mortality on its own.[6]
The adverse effects of UPTRAVI® are a marker of IP receptor stimulation and, therefore, of drug activity.[12] Tolerability of these adverse effects helps to determine each patient’s individualised maintenance dose of UPTRAVI®.[6][8][13]
Managing UPTRAVI® adverse effects can be straightforward with over-the-counter medications, prescription medications and/or non-pharmacological interventions.[8][13][14]
UPTRAVI® has a predictable and manageable safety profile.[9][12]
Learn about the patient profiles identified as benefiting from UPTRAVI® initiation.[3]
Guidance on correctly starting your patient on their UPTRAVI® journey.
BID, twice daily; CI, confidence interval; DPAH, drug- or toxin-associated pulmonary arterial hypertension; ERA, endothelin receptor antagonist; ERS, European Respiratory Society; ESC, European Society of Cardiology; HPAH, heritable pulmonary arterial hypertension; HR, hazard ratio; IP, prostacyclin; IPAH, idiopathic pulmonary arterial hypertension; IV, intravenous; PAH, pulmonary arterial hypertension; PDE-5i, phosphodiesterase type 5 inhibitor; SC, subcutaneous
For further information regarding Opsumit® (macitentan) or Uptravi® (Selexipag) including full indications, all adverse effects and data please refer to the Israeli MOH prescribing information: https://israeldrugs.health.gov.il/#!/byDrug