According to a recent meta-analysis published in the American Journal of Cardiovascular Drugs, patients with pulmonary arterial hypertension (PAH) were consistent with their targeted PAH treatment in only 60.9% of cases, while 42.3% of the pooled population discontinued the use of medication for various reasons.

The main objective of the study was to investigate treatment adherence and discontinuation in patients with PAH. After the study authors searched through MEDLINE, EMBASE, and the Cochrane Library for relevant scientific publications, 14 studies involving 14,861 participants were discovered.

PAH-targeted treatments included endothelin receptor antagonists, phosphodiesterase type 5 inhibitors, soluble guanylate cyclase stimulators, and prostanoids. Next, the researchers conducted a random-effects meta-analysis to gain insight into the average adherence and discontinuation rates.

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The results indicated that 60.9% of the overall pooled patients complied with their treatment regimen. Questionnaire-based studies reported that 52.9% of patients with PAH took their medication regularly, while studies using prescription/dispensing data noted this in 62.9% of patients. Among the patients receiving oral therapies, the pooled proportion that took their medication regularly was 65.9%.

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On the other hand, 42.3% of the overall pooled patients did not comply with their treatment regimen. The reasons for treatment cessation included high administration frequency, greater length of time on treatment, the use of compliance aids, high copayments, and the occurrence of adverse events.

“These findings are concerning as poor medication adherence and persistence complicates disease management, and is associated with adverse clinical outcomes such as hospitalizations, increased healthcare resource use, and death,” Qadus and colleagues wrote. “Multifaceted interventions are needed to address the varied drivers of nonadherence to and nonpersistence with PAH-targeted therapies.”

The use of PAH-specific medications is associated with symptom relief and lower mortality risk; however, it might be a particular challenge for people who only experience occasional discomfort.


Qadus S, Naser AY, Ofori-Asenso R, Ademi Z, Al Awawdeh S, Liew D. Adherence and discontinuation of disease-specific therapies for pulmonary arterial hypertension: a systematic review and meta-analysis. Am J Cardiovasc Drugs. Published online November 25, 2022. doi:10.1007/s40256-022-00553-6