ISHLT2022 Roving Reporters – Reports from Pulmonary Vascular Disease

Saturday, 30 April, 2022

The literature year in review was very exciting for pulmonary vascular disease because of the results of three very exciting trials in pulmonary hypertension. Edith Boyes, APN, from Amita Health in Chicago, IL USA, presented, and Christopher King, MD, FACP, FCCP, of Inova Fairfax Hospital in Falls Church, VA USA discussed the three pivotal trials that resulted in the pulmonary vascular world since we last met in Orlando in 2019.

The first discussion centered on the results of the INCREASE Trial, which was a 16-week trial of inhaled prostacyclin (Treprostinil) in patients with WHO Group 3 pulmonary hypertension due to interstitial lung disease. Patients were randomized to either placebo or drug, and the outcome was six-minute walk distance. This was the first positive trial in WHO Group 3 PH! Patients had a 31-meter improvement in six-minute walk distance at 16 weeks with an improvement in NT-proBNP and time to clinical worsening.

The next trial discussed was the PULSAR Trial, which was a Phase 2, 24-week trial of sotatercept in patients with WHO Group 1 PAH. Sotatercept is a ligand trap that aims to rebalance activin/GDF versus BMP signaling. In the PULSAR study there was an improvement in pulmonary vascular resistance, six-minute walk distance, and NT-proBNP. This trial is very exciting for the future of PAH. While not discussed in this ISHLT session, the open label extension was recently presented at the American Thoracic Society meeting, and the drug was very well tolerated in the open label extension. Further, patients who crossed over from placebo to sotatercept caught up in terms of reduction in pulmonary vascular resistance!

The final trial discussed was the TRITON trial, which was a Phase 3 trial of upfront dual combination therapy with macitentan and tadalafil versus upfront combination triple therapy with selexipag, macitentan, and tadalafil. The trail did not show any improvement in pulmonary vascular resistance, six-minute walk distance, or NT-proBNP. However, there was a trend towards a reduced risk for disease progression. The discussion was interesting, centering on clinical trial design and implications for treatment.
– Summary by Nicholas Kolaitis, MD, MAS

Highlights of Advanced Heart Disease and Cardiac Transplantation
Asvin Ganapathi, MD
, The Ohio State University Wexner Medical Center, Columbus, OH USA

Expert Discussant in Advanced Heart Disease and Cardiac Transplantation
Hermann Reichenspurner, MD, PhD
, University Heart Centre Hamburg, Hamburg, Germany

Highlights of Advanced Lung Disease and Lung Transplantation
Erin Lowery, MD
, University of Wisconsin-Madison, Madison, WI USA

Expert Discussant in Advanced Lung Disease and Transplantation
Allan R. Glanville, MBBS, MD, FRACP
, St. Vincent’s Hospital, Sydney, Australia

Highlights of Mechanical Circulatory Support
Jamila Kremer, MD
, University Hospital Heidelberg, Heidelberg, Germany

Expert Discussant in Mechanical Circulatory Support
Stephan M. Ensminger, MD, DPhil
, University of Lubeck, Lubeck, Germany

Highlights of Pulmonary Vascular Disease (PAH & CTEPH)
Edith Boyes, APN
, Amita Health, Chicago, IL USA

Expert Discussant in Pulmonary Vascular Disease (PAH & CTEPH)
Christopher King, MD, FACP, FCCP
, Inova Fairfax Hospital, Falls Church, VA USA