Selexipag for the treatment of pulmonary arterial hypertension

ABSTRACT

Introduction: Targeted pulmonary vasoactive substances are the cornerstone of treatment in pulmonary arterial hypertension (PAH). Approved drugs act on various receptors and molecules within the pulmonary arteries, mainly causing pulmonary vasodilation and potentially reversing remodeling with consequent improvement of right ventricular function. A key role is attributed to the prostacyclin pathway and especially the prostacyclin receptor (IP). Selexipag is a recently developed, non-prostanoid, oral IP receptor agonist for the treatment of PAH which has been approved in countries/regions including the USA and Europe.

Areas covered: We review the discovery and development of drugs targeting IP receptors in PAH and describe preclinical and phase I studies of selexipag. Furthermore, we review important phase II and III selexipag studies and place them into the clinical context of previously approved prostanoids.

Expert opinion: Oral selexipag offers a promising therapeutic option within the class of available drugs targeting IP receptors. However, its role as first-line therapy based on its efficacy/side-effect profile in current studies is questionable. Most likely, selexipag will be used in combination with other PAH-specific oral drugs. The potential of selexipag to replace or postpone the use of inhaled or parenteral prostanoids needs to be investigated in future trials.

KEYWORDS:

• Prostacyclin receptor agonist
• pulmonary arterial hypertension
• selexipag
• treatment

Declaration of interest

MJ Richter has received support from United Therapeutics and Bayer Pharma AG, and speaker fees from Actelion, Mundipharma, Roche, and United Therapeutics. H Gall has received fees from Actelion, AstraZeneca, Bayer, GlaxoSmithKline, Janssen-Cilag, Lilly, Novartis, OMT Pharma, Pfizer, and United Therapeutics. F Grimminger has received research grants from Bayer Pharma AG, Pfizer, Ergonex, and Encysive; honoraria from Bayer Pharma AG, Pfizer, Actelion, Encysive, and Novartis; and has been a paid consultant for Nycomed (Altana Pharma). HA Ghofrani has received consultancy fees from Bayer, Actelion, Pfizer, Merck, GlaxoSmithKline, and Novartis; fees for participation in advisory boards from Bayer, Pfizer, GlaxoSmithKline, Actelion, and Takeda; lecture fees from Bayer HealthCare, GlaxoSmithKline, Actelion, and Encysive/Pfizer; industry-sponsored grants from Bayer HealthCare, Aires, Encysive/Pfizer, and Novartis; and sponsored grants from the German Research Foundation, Excellence Cluster Cardiopulmonary Research, and the German Ministry for Education and Research. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. Writing assistance was utilised in the preparation of this manuscript, it was funded by the University of Giessen and Marburg Lung Center (UGMLC), Giessen, Germany and carried out by Claire Mulligan (Beacon Medical Communications Ltd, Brighton, UK).

Additional information

Funding

This paper was funded by University of Giessen and Marburg Lung Center (UGMLC), Giessen, Germany.