Characteristics of patients treated for pulmonary arterial hypertension in real-world database representing a large US health plan

Introduction: Pulmonary arterial hypertension (PAH) is a chronic and progressive disease that can result in right heart failure and mortality. Objective: To examine the characteristics and treatment patterns of patients newly treated for PAH in a large real-world US managed care database. Methods: Patients with a diagnosis code for pulmonary hypertension and treated with an approved medication for PAH identified by pharmacy claims between January 2012 and March 2017 were included. Patients were ≥18 years old with continuous enrollment with medical and pharmacy coverage for 6 months before (with no PAH pharmacy claim) and ≥1 year after initiating a PAH-related medication. Patients were followed up to >5 years until disenrollment from the plan or March 2018. Results: The study included 1878 patients, mostly female (64.4%) with mean age 66.4±13.3 years, Charlson score 3.3±2.0 (67% >3), and followed 2.4±1.3 years. Comorbidities included hypertension (81.7%), heart failure (58.8%), coronary artery disease (52.2%), type 2 diabetes mellitus (40.9%), sleep apnea (38.3%), respiratory insufficiency (36.1%), and obesity (28.8%). Only 9.2% of patients initiated treatment with a combination therapy, although combination therapies comprised 50.4% of second regimens, mostly within 9 months. Only 37.8% of patients remained on their initial medication regimen until study end. Many patients (43.0%) had a PAH-related inpatient admission during follow-up. Conclusion: PAH patients presented with complex and fragile comorbidity profiles consistent with previously published data. Follow-up was commonly marked by modifications to medication regimens and inpatient admissions.