Transitioning From Parenteral Prostanoids to Oral Selexipag in Pulmonary Arterial Hypertension: A Multicenter Retrospective Cohort Study
Bibliographic record
Abstract
ABSTRACT Transition from parenteral prostanoids to oral selexipag may be considered in select patients with pulmonary arterial hypertension (PAH) to reduce the therapeutic burden imposed on patients and caregivers, but its safety and efficacy remain uncertain. A retrospective cohort study was conducted involving adult patients with PAH who transitioned from parenteral prostanoids to selexipag at Canadian tertiary referral centers between January 2016 and November 2020. The primary outcome was transition failure at 12 months, defined as a composite of death or PAH‐related worsening. Baseline predictors of transition failure were identified using univariate Cox regression, with follow‐up data collected up to 36 months post‐transition or until site‐specific data submission, occurring between May 2021 and February 2023. At 12 months post‐transition, 11 of 36 patients (31%) experienced transition failure, including 4 deaths, all classified as high‐risk pre‐transition. Of the 25 patients (69%) who successfully transitioned, only one (4%) experienced transition failure over the subsequent observation period (median follow‐up 28 months). Pre‐transition variables protective against transition failure included a right atrial pressure (RAP) < 8 mmHg (HR 0.290, 95% CI 0.084–0.999, p = 0.049), absence of hospitalizations in the year preceding transition (HR 0.239, 95% CI 0.064–0.885, p = 0.032), lower brain natriuretic peptide (< 50 pg/mL)/N‐terminal pro‐B‐type natriuretic peptide (< 300 pg/mL) levels (HR 0.174, 95% CI 0.045–0.676, p = 0.011), and REVEAL 2.0 score < 7 (HR 0.162, 95% CI 0.049–0.541, p = 0.003). These findings suggest that transition from parenteral prostanoids to selexipag carries the risk of clinical deterioration and should only be considered in carefully selected, low‐risk patients.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".