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EXPLORATORY POST HOC ANALYSIS: TRIPLE‍-‍COMBINATION SUBGROUP

GRIPHON Is the First and Only Completed PAH Event‍-‍Driven Trial That Included Patients Treated With Triple‍-‍Combination Therapy1-3

Baseline patient characteristics4

Background therapy: ERA + PDE5i

33% (n=376/1156; 31% FC II and 68% FC III)*

Etiology

  • 64%
    IPAH/HPAH
    (n=242/376)
  • 26%
    PAH-CTD
    (n=96/376)
  • 5%
    PAH-CHD
    (n=20/376)
  • 5%
    Other
    (n=18/376)

Time from diagnosis (mean)

  • 4 years
    UPTRAVI®
  • 3.6 years
    Placebo
Time to first disease progression event in patients receiving ERA + PDE5i at baseline (UPTRAVI® vs placebo)4

Summary of primary endpoint events in patients receiving ERA + PDE-5i at baseline4


UPTRAVI® n=179
% (n)
Placebo n=197
% (n)
PRIMARY COMPOSITE ENDPOINT:
Morbidity/mortality up to end of treatment period||
All primary endpoint events26.3% (47)40.6% (80)
Hospitalization for PAH15.1% (27)21.8% (43)
Other disease progression
(decrease in 6MWD plus worsening FC or need for other therapy)
6.6% (38)17.2% (100)
Death4.9% (28)3.1% (18)
Parenteral prostanoid or chronic oxygen therapy1.7% (10)2.2% (13)
Need for lung transplantation or balloon atrial septostomy for worsening of PAH0.2% (1)0.3% (2)

Patients receiving an ERA and a PDE5i at baseline were a prespecified subgroup for evaluation of the GRIPHON primary endpoint; however, the more detailed analyses described on this page are exploratory and post hoc. Sample size should be considered and results should be interpreted with caution.

Adverse reactions in triple-combination subgroup occurring more frequently with UPTRAVI® compared with placebo by ≥3%4


ADVERSE REACTIONUPTRAVI® n=179
% (n)
Placebo
n=197
% (n)
Headache76% (136)39% (76)
Diarrhea56% (100)26% (52)
Nausea48% (85)25% (49)
Pain in jaw41% (74)10% (20)
Vomiting24% (42)11% (21)
Pain in extremity23% (41)10% (20)
Flushing20% (36)8% (16)
Myalgia13% (24)4% (8)
Bronchitis12% (21)9% (17)

Baseline patient characteristics4

Background therapy in FC II patients: ERA + PDE5i

10% (n=115/1156)

Etiology

  • 70%
    IPAH/HPAH
    (n=80/115)
  • 18%
    PAH-CTD
    (n=21/115)
  • 6%
    PAH-CHD
    (n=7/115)
  • 6%
    Other
    (n=7/115)

Time from diagnosis (mean)

  • 4.3 years
    UPTRAVI®
  • 3.6 years
    Placebo
Time to first disease progression event in FC II patients receiving ERA + PDE5i at baseline (UPTRAVI® vs placebo)4

Summary of primary endpoint events in FC II patients receiving ERA + PDE5i at baseline4


UPTRAVI®
n=55
% (n)
Placebo
n=60
% (n)
PRIMARY COMPOSITE ENDPOINT:
Morbidity/mortality up to end of treatment period||
All primary endpoint events10.9% (6)30.0% (18)
Hospitalization for PAH5.5% (3)13.3% (8)
Other disease progression
(decrease in 6MWD plus worsening FC or need for other therapy)
1.8% (1)8.3% (5)
Death0% (0)1.7% (1)
Parenteral prostanoid or chronic oxygen therapy3.6% (2)5.0% (3)
Need for lung transplantation or balloon atrial septostomy for worsening of PAH0% (0)1.7% (1)

Patients receiving an ERA and a PDE5i at baseline were a prespecified subgroup for evaluation of the GRIPHON primary endpoint; however, the more detailed analyses described on this page are exploratory and post hoc. Sample size should be considered and results should be interpreted with caution.

Adverse reactions in FC II triple-combination subgroup occurring more frequently with UPTRAVI® compared with placebo by ≥3%4


ADVERSE REACTIONUPTRAVI®
n=55
% (n)
Placebo
n=60
% (n)
Headache78% (43)30% (18)
Diarrhea58% (32)13% (8)
Nausea55% (30)20% (12)
Pain in jaw38% (21)5% (3)
Vomiting24% (13)12% (7)
Pain in extremity15% (8)7% (4)
Flushing16% (9)8% (5)
Myalgia15% (8)2% (1)
Fatigue15% (8)10% (6)
Bronchitis13% (7)8% (5)
Abdominal pain15% (8)8% (5)
Decreased appetite11% (6)5% (3)

Baseline patient characteristics4

Background therapy in FC III patients: ERA + PDE5i

22% (n=255/1156)

Etiology

  • 61%
    IPAH/HPAH
    (n=156/255)
  • 29%
    PAH-CTD
    (n=75/255)
  • 5%
    PAH-CHD
    (n=13/255)
  • 4%
    Other
    (n=11/255)

Time from diagnosis (mean)

  • 3.9 years
    UPTRAVI®
  • 3.6 years
    Placebo
Time to first disease progression event in FC III patients receiving ERA + PDE5i at baseline (UPTRAVI® vs placebo)4
Patients without an event in the triple combination subgroup desktop curve

Summary of primary endpoint events in FC III patients receiving ERA + PDE5i at baseline4


UPTRAVI®
n=122
% (n)
Placebo
n=133
% (n)
PRIMARY COMPOSITE ENDPOINT:
Morbidity/mortality up to end of treatment period||
All primary endpoint events33.6% (41)44.4% (59)
Hospitalization for PAH19.7% (24)24.8% (33)
Other disease progression
(decrease in 6MWD plus worsening FC or need for other therapy)
8.2% (10)12.0% (16)
Death3.3% (4)1.5% (2)
Parenteral prostanoid or chronic oxygen therapy2.5% (3)5.3% (7)
Need for lung transplantation or balloon atrial septostomy for worsening of PAH0% (0)0.75% (1)

Patients receiving an ERA and a PDE5i at baseline were a prespecified subgroup for evaluation of the GRIPHON primary endpoint; however, the more detailed analyses described on this page are exploratory and post hoc. Sample size should be considered and results should be interpreted with caution.

Adverse reactions in FC III triple-combination subgroup occurring more frequently with UPTRAVI® compared with placebo by ≥3%4


ADVERSE REACTIONUPTRAVI®
n=122
% (n)
Placebo
n=133
% (n)
Headache75% (91)43% (57)
Diarrhea54% (66)31% (41)
Nausea43% (53)27% (36)
Pain in jaw43% (52)12% (16)
Vomiting23% (28)10% (13)
Pain in extremity26% (32)12% (16)
Flushing21% (26)8% (11)
Myalgia13% (16)5% (7)

*Included 6 patients with WHO FC IV symptoms at baseline.

Other=drugs and toxins (4%) and HIV (1%) in overall population; drugs and toxins (4%) and HIV (3%) in FC II patients; drugs and toxins (4%) and HIV (<1%) in FC III patients.

Not adjusted for multiplicity.

§Hazard ratio based on primary endpoint events up to the end of treatment.

Treatment period defined as 7 days since last intake of UPTRAVI® or placebo.

6MWD=6-minute walk distance; CI=confidence interval; ERA=endothelin receptor antagonist; FC=Functional Class; GRIPHON=Prostacyclin (PGI2) Receptor Agonist In Pulmonary Arterial HypertensiON; HIV=human immunodeficiency virus; HPAH=heritable PAH; HR=hazard ratio; IPAH=idiopathic PAH; IV=intravenous; PAH-CHD=PAH associated with congenital heart disease with repaired shunts; PAH-CTD=PAH associated with connective tissue disease; PDE5i=phosphodiesterase type-5 inhibitor; SC=subcutaneous; WHO=World Health Organization.

References: 1. UPTRAVI® (selexipag) full Prescribing Information. Actelion Pharmaceuticals US, Inc. 2. Ruopp NF, Cockrill BA. Diagnosis and treatment of pulmonary arterial hypertension: a review. JAMA. 2022‍;‍327‍(‍14‍)‍:‍1379‍-‍1391. 3. Hoeper MM, Badesch HA, Ghofrani HA, et al; STELLAR Trial Investigators. Phase 3 trial of sotatercept for treatment of pulmonary arterial hypertension. N Engl J Med. 2023‍;‍388‍(‍16‍)‍:‍1478‍-‍1490. 4. Coghlan JG, Channick R, Chin K, et al. Targeting the prostacyclin pathway with selexipag in patients with pulmonary arterial hypertension receiving double combination therapy: insights from the randomized controlled GRIPHON study. Am J Cardiovasc Drugs. 2018‍;‍18‍(1)‍:‍37‍-‍47.