# Exploring patient preferences regarding the use of combination therapy with endothelin receptor antagonist (ERA) + phosphodiesterase-5 inhibitors (PDE5i)

## TL;DR

This study explores how patients with pulmonary arterial hypertension prefer combination therapies, finding that a single tablet could reduce pill burden and improve adherence.

## Contribution

The novel contribution is identifying patient preferences for a single tablet combination therapy in PAH management.

## Key findings

- 83.1% of patients believed single tablet combination therapy would reduce pill consumption.
- Out-of-pocket costs and dosing regimen were top factors influencing therapy choice.
- STCT could improve treatment initiation and adherence, but cost remains a significant barrier.

## Abstract

To evaluate patient preferences for endothelin receptor antagonist (ERA) + phosphodiesterase-5 inhibitor (PDE5i) combination therapies in managing pulmonary arterial hypertension (PAH), including the potential benefits of a single tablet combination therapy (STCT) in reducing pill burden and improving adherence.

An online survey was administered to 201 adult patients with PAH residing in the United States. Patients' preferences toward oral PAH therapies, including willingness to use double combination ERA+PDE5i therapy, were assessed using a discrete choice experiment (DCE).

Respondents were predominantly White (86.1%) and female (88.6%), with a median age of 59 years. Most were not employed (56.2%), and 38.3% reported a disability. At the time of the survey, 36.8% were on triple therapy (PDE5i + ERA + prostacyclin), 17.9% on dual therapy (PDE5i + ERA), and the remaining on other or no therapy. Out-of-pocket costs and dosing regimen were the top factors influencing therapy choice in the DCE, with patients preferring lower out-of-pocket costs and simpler dosing regimens. Regarding STCT, 83.1% believed it would reduce pill consumption, 68.7% thought it would decrease time spent managing prescriptions, and 34.8% and 39.3% anticipated improvements in treatment initiation and adherence, respectively.

STCT offers potential benefits in reducing pill burden, improving convenience, and possibly facilitating treatment initiation and adherence. However, cost remains a significant factor influencing patient decision-making in PAH therapy in the United States. Addressing cost concerns may increase the acceptance of ERA + PDE5i therapies and STCT among patients with PAH.