# Impact of treatment escalation on rehospitalization among patients with pulmonary arterial hypertension

## TL;DR

This study finds that escalating treatment to combination therapy for pulmonary arterial hypertension reduces rehospitalization rates compared to continuing monotherapy.

## Contribution

The study provides evidence that early treatment escalation to combination therapy lowers rehospitalization rates in PAH patients.

## Key findings

- Patients on combination therapy had a 31% lower rehospitalization rate than those on monotherapy.
- The most common combination therapies were PDE5i + ERA and PDE5i + PPA.

## Abstract

Pulmonary arterial hypertension (PAH) poses a substantial burden, including hospitalizations. This study assessed the impact of treatment escalation on rehospitalization. The Komodo Research Data (10/2015–03/2022) was used to identify adults with ≥ 1 PAH-related hospitalization (index: first hospitalization). Patients on monotherapy pre-index were assigned to the Escalation-to-combination cohort (treatment added ≤ 90 days post-index) or the Monotherapy cohort (no treatment change ≤ 90 days post-index). A sensitivity analysis was conducted among all patients who were treated pre-index. Entropy balancing was used to create cohorts with similar characteristics. All-cause hospitalizations per-patient-per-month (PPPM) during ≤ 12 months post-index were compared across balanced cohorts. A total of 203 and 1252 patients were included in the Escalation-to-combination and Monotherapy cohorts, respectively (mean age: 61 vs. 62 years; 67% vs. 68% female); most received PDE5i monotherapy pre-index (65.3% vs. 75.9%). Post-index, 84.5% of the Escalation-to-combination cohort increased to dual therapy, most commonly PDE5i + ERA (39.4%) and PDE5i + PPA (24.7%). Rehospitalization was lower in the Escalation-to-combination than Monotherapy cohort (incidence rate ratio [95% confidence interval]: 0.69 [0.55–0.90]; p < 0.001); the sensitivity analysis yielded similar results. Treatment escalation was associated with a lower rehospitalization rate, suggesting that earlier escalation and broader use of combination therapy may reduce PAH burden.