Selexipag: still looking for its place

Abstract

Extract

Selexipag, an orally available prostacyclin receptor agonist, is globally approved for the treatment of pulmonary arterial hypertension (PAH) and has also been investigated in patients with chronic thromboembolic pulmonary hypertension (CTEPH). In 2022, the European Respiratory Journal published the results of a randomised, double-blind, placebo-controlled trial involving 78 Japanese patients with CTEPH who were inoperable or had persistent pulmonary hypertension after pulmonary endarterectomy (PEA) or pulmonary balloon angioplasty (BPA) [1]. This study met its primary endpoint, showing a placebo-corrected change in pulmonary vascular resistance (PVR) of –93.5 dyn·s·cm^–5 after 20 weeks. However, no significant improvements were observed in 6-min walk distance and World Health Organization functional class (WHO-FC). Clinical worsening events occurred in one patient assigned to selexipag and one patient assigned to placebo. Based on this study, selexipag was approved for the treatment of CTEPH in Japan.