Transitioning Prostacyclin Pathway Agents to Oral Selexipag in Patients with Pulmonary Arterial Hypertension: A Systematic Literature Review

INTRODUCTION: Oral selexipag is indicated to delay disease progression and reduce risk of pulmonary arterial hypertension (PAH)-related hospitalization, as demonstrated in GRIPHON. There are situations when clinicians or patients may need or want to transition from parenteral, oral, and inhaled prostacyclin pathway agents (PPAs) to oral selexipag. This systematic literature review (SLR) examined published evidence on such transitions in adults. METHODS: A SLR was conducted in Medline and Embase for publications from January 01, 2015 to September 25, 2024. Two reviewers independently screened abstracts and full texts; one extracted relevant data. RESULTS: Overall, 1730 publications were identified, with 48 included. Of these, 32 transitions from treprostinil and 16 from epoprostenol to oral selexipag were identified. Patient ages ranged from 19 to 78 years, with varying risk status and scores, functional classes, and comorbidities. Reasons for transition were patient-specific, with publications generally following GRIPHON and Food and Drug Administration (FDA) label protocols. CONCLUSION: This review highlights cases where oral selexipag may be a suitable option when clinicians and patients participate in shared decision-making considering safety and risks/benefits. Transitions should be individualized based on clinical assessment, with appropriate monitoring and follow-up.