TY - JOUR
T1 - Use of selective serotonin reuptake inhibitors and outcomes in pulmonary arterial hypertension
AU - Sadoughi, Ali
AU - Roberts, Kari E.
AU - Preston, Ioana R.
AU - Lai, Ginny P.
AU - McCollister, Deborah H.
AU - Farber, Harrison W.
AU - Hill, Nicholas S.
N1 - Funding Information:
Funding/Support: Funding and support for the REVEAL Registry was provided by CoTherix, Inc, and its affiliate Actelion Pharmaceuticals US, Inc. Medical writing support was provided by Scarlett Geunes-Boyer, PhD, of inScience Communications, Springer Science+Business Media, and funding was provided by Actelion Pharmaceuticals US, Inc.
Funding Information:
Financial/nonfinancial disclosures: The authors have reported to CHEST the following conflicts of interest: Dr Sadoughi has received grant support from Empire Clinical Research Investigator Program. Dr Roberts receives grant support from the National Institutes of Health [ Grant K23HL089812 ]. Dr Preston serves as a consultant to Actelion Pharmaceuticals US Inc; Aires Pharmaceuticals, Inc; Bayer AG; Gilead; Novartis Corporation; Pfizer, Inc; and United Therapeutics Corporation. Dr Preston also participates in speaking activities and/or advisory committees for Actelion Pharmaceuticals US Inc, Gilead, and United Therapeutics Corporation. Ms Lai is employed by ICON Late Phase & Outcomes Research, a company that receives research support from Actelion Pharmaceuticals US Inc and other pharmaceutical companies. Ms McCollister serves as a consultant to Actelion Pharmaceuticals US Inc; Gilead; Bayer AG; Novartis Corporation; Ikaria, Inc; and United Therapeutics Corporation. Dr Farber serves as a consultant and is on the speaker's bureau for Actelion Pharmaceuticals US Inc. Dr Farber has received honoraria for service on the REVEAL Registry Steering Committee, which is supported by Actelion Pharmaceuticals US Inc. Dr Hill receives grants from Actelion Pharmaceuticals US Inc; Bayer AG; Gilead; Novartis Corporation; Pfizer, Inc; and United Therapeutics Corporation. Relevant to Dr Hill's honoraria, all industries listed provided research grants for multicenter or investigator-initiated trials, with all money going to Tufts Research Administration and no direct payments to the author.
PY - 2013/8
Y1 - 2013/8
N2 - Background: Selective serotonin reuptake inhibitors (SSRIs) have been suggested to offer therapeutic benefi t in patients with pulmonary arterial hypertension (PAH). We conducted two analyses to explore the association between SSRI use and PAH outcomes using the Registry to Evaluate Early and Long-term PAH Disease Management (REVEAL Registry). Methods: First, new users (SSRI-naive patients who initiated treatment after enrollment, incident use analysis, n = 220) were matched (1:2) with non-SSRI users (nonusers, n = 440) by enrollment center, sex, date of most recent visit, age, and 6-min walk distance. Second, a cross-sectional design was used to compare nonusers (n = 2,463), high-affi nity SSRI users (n = 430), and non-high-affi nity SSRI users (n = 125) at enrollment. Mortality and a composite end point defi ned by events indicative of clinical worsening were evaluated. Results: New users had a higher risk of death (unadjusted hazard ratio [HR], 1.74; 95% CI, 1.19-2.54; P = .004) and were less likely to be free from the composite end point 2 years after enrollment vs nonusers (25.7% vs 43.2%, respectively; P < .001). Similarly, among prevalent SSRI users (patients with a history of SSRI use at enrollment), high-affi nity SSRI users were less likely to be free from the composite end point vs nonusers (unadjusted HR, 1.20; 95% CI, 1.07-1.36; P = .003). In both analyses, differences in outcome were maintained after adjustment for clinical variables previously associated with PAH outcomes. Conclusions: In a large population of patients with PAH, incident SSRI use was associated with increased mortality and a greater risk of clinical worsening, although we could not adjust for all potential confounders.
AB - Background: Selective serotonin reuptake inhibitors (SSRIs) have been suggested to offer therapeutic benefi t in patients with pulmonary arterial hypertension (PAH). We conducted two analyses to explore the association between SSRI use and PAH outcomes using the Registry to Evaluate Early and Long-term PAH Disease Management (REVEAL Registry). Methods: First, new users (SSRI-naive patients who initiated treatment after enrollment, incident use analysis, n = 220) were matched (1:2) with non-SSRI users (nonusers, n = 440) by enrollment center, sex, date of most recent visit, age, and 6-min walk distance. Second, a cross-sectional design was used to compare nonusers (n = 2,463), high-affi nity SSRI users (n = 430), and non-high-affi nity SSRI users (n = 125) at enrollment. Mortality and a composite end point defi ned by events indicative of clinical worsening were evaluated. Results: New users had a higher risk of death (unadjusted hazard ratio [HR], 1.74; 95% CI, 1.19-2.54; P = .004) and were less likely to be free from the composite end point 2 years after enrollment vs nonusers (25.7% vs 43.2%, respectively; P < .001). Similarly, among prevalent SSRI users (patients with a history of SSRI use at enrollment), high-affi nity SSRI users were less likely to be free from the composite end point vs nonusers (unadjusted HR, 1.20; 95% CI, 1.07-1.36; P = .003). In both analyses, differences in outcome were maintained after adjustment for clinical variables previously associated with PAH outcomes. Conclusions: In a large population of patients with PAH, incident SSRI use was associated with increased mortality and a greater risk of clinical worsening, although we could not adjust for all potential confounders.
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U2 - 10.1378/chest.12-2081
DO - 10.1378/chest.12-2081
M3 - Article
C2 - 23558791
AN - SCOPUS:84881535681
SN - 0012-3692
VL - 144
SP - 531
EP - 541
JO - Chest
JF - Chest
IS - 2
ER -