Real-world Persistence on Selexipag for Pulmonary Arterial Hypertension in Canada.

Background: Safety and tolerability of selexipag in pulmonary arterial hypertension (PAH) was demonstrated in a phase 3 clinical trial. In this trial, up to 14% of patients receiving selexipag over a median period of 70 weeks prematurely discontinued therapy due to adverse events. However, no data are available on real-world persistence on selexipag in Canada. This study aimed to describe selexipag short and long-term persistence, and predictors of persistence in the Canadian population. Methods: This retrospective claims-database analysis included adult PAH patients with ≥ 1 selexipag claim between April 2016 and July 2021. Patients were followed for a maximum of 64 months. Kaplan-Meier estimates of persistence were calculated from the index date to the earliest date of discontinuation or censoring. Four models were used to select predictors of persistence, and the 12 most important features based on average rank were built into a Cox proportional hazards model to assess the impact of these predictors on patient persistence with selexipag. Results: A total of 311 patients (70% female; 71% aged 50-79 years) were included in the study. The Kaplan-Meier estimates of persistence at 6, 12, 24, and 36 months were 76.1%, 61.7%, 48.3%, and 40.2% respectively. The median duration of persistence for the overall cohort was 22 months. No predictors in the final model were significant. Conclusions: Real-world data from the Canadian population suggest a low level of long-term persistence on selexipag, although the level of persistence is similar to reported rates for other PAH therapies. Further research into predictors of selexipag persistence is needed to help optimize potential treatment outcomes.