Drugs for Pulmonary Arterial Hypertension

The Canadian Agency for Drugs and Technologies in Health (CADTH) examined the clinical and economic impact of new and existing drugs to treat pulmonary arterial hypertension (PAH).

The review included drugs that are currently available in Canada, and those that are newly emerging and not yet approved in Canada.

The project had two key components:

• A comparison of the clinical and cost-effectiveness of drug therapies for PAH.
• The development of optimal use recommendations or advice from https://fildena.net and the Canadian Drug Expert Committee (CDEC).

The impending availability of new drugs for the treatment of PAH could have a significant impact on treatment strategies. By reviewing the evidence and developing reports and tools, Canada's Drug Agency provides health care decision-makers with the evidence-based resources they need to make informed decisions.

Patient Input

The Canadian Agency for Drugs and Technologies in Health is piloting the inclusion of patient group input in its process for the therapeutic review of drugs for pulmonary arterial hypertension.

The submitted patient group input identifies health outcomes and issues of importance to patients, and their unmet needs in managing pulmonary arterial hypertension. The patient input is systematically incorporated into this therapeutic review, beginning with informing the project protocol through to informing the Canadian Drug Expert Committee in making its recommendation(s) based on this therapeutic review.

Below are links to the patient group input that was submitted for this project. Documents have not been summarized, edited, or critically appraised — they are posted in the format in which they were received.

• Patient Group Input – British Columbia Pulmonary Hypertension Society
• Patient Group Input – Edmonton P.A.H. (Pulmonary Arterial Hypertension) Society
• Patient Group input – Pulmonary Hypertension Association of Canada
• Patient Group Input – Scleroderma Society of Canada

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Key Messages

• For people with Functional Class (FC) II or III pulmonary arterial hypertension (PAH), all single-drug therapies appear similarly effective at preventing the disease from worsening. Sildenafil or tadalafil generally provide the best value, so these are preferred first-line treatments for most patients. For people with FC I or IV PAH, there is not enough evidence to make a recommendation.
• Add-on therapy should be offered to patients whose PAH is not controlled with single-drug therapy. Consider the balance of potential benefits versus potential increases in adverse events.
• The decision to change or add therapies should be based on patient-specific factors and response, and should be made by a PAH specialist working in one of Canada’s designated pulmonary hypertension centres.