Earlier the better for PAH treatment, RCT shows

The benefits of initiating selexipag early in PAH has been further strengthened in the latest review of the GRIPHON trial – the largest RCT on PAH to date.

The new post hoc analyses looked at the effect of time from diagnosis to initiation of selexipag based on treatment response with respect to mortality and morbidity events – the combined  primary endpoint

While selexipag delayed disease progression and reduced hospitalisations in all groups compared to placebo, those treated with the oral IP prostacyclin receptor agonist within six months after diagnosis experienced the most pronounced effects from treatment, say investigators.

Selexipag reduced the risk of morbidity or mortality by 55% in newly diagnosed patients (HR 0.45 [95% CI 0.33–0.63]) and by 26% in patients with a longer time from diagnosis (HR 0.74 [95% CI 0.57–0.96]) compared with placebo.

The pattern was observed regardless of background PAH therapy subgroups, according to the researchers.

Meanwhile the study has also confirmed that newly diagnosed PAH patients have a worse prognosis than those with a longer time from diagnosis with more patients in the newly diagnosed subgroup dying (62 selexipag patients and 61 placebo patients)  by the end of the study compared to patients with a longer time from diagnosis (38 selexipag vs 44 placebo).

Yet despite their poorer prognosis, researchers say newly diagnosed PAH patients can respond to and benefit from early targeting of the prostacyclin pathway with selexipag indicating that newly diagnosed patients benefit from early initiation of therapy.

Spike in empyema following introduction of 13-valent pneumococcal vaccine

Cases of empyema hospitalisations among children in Australia have spiked between 2007 and 2017, according to a new study.

The significant rise in childhood empyema hospital admissions – 25% – comes off the back of a 21% decrease in childhood bacterial pneumonia hospitalisations over the same period following the introduction of the 13vPCV on the Australian NIP.

The study highlights the potential negative impact of 13vPCV on childhood empyema by potentially causing serotype (ST) replacement disease, say the researchers led by investigators from the Department of Respiratory Medicine at the Sydney Children’s Hospital.

Although there was a substantial reduction in the 13vPCV ST ST1 – which appears to have been eliminated as an important cause of empyema among Australian children – Serotype 3 is now the predominant causative organism of childhood empyema suggesting the emergence of non-vaccine STs.

Researchers say the recent change in the Australian NIP from the unboosted 3+0 schedule to a boosted ‘2+1’ (2, 4 and 12 months) schedule may increase effectiveness of 13vPCV against ST3 and ST19A but caution that there is a need for enhanced molecular surveillance following the introduction of new vaccines onto national programs.

PPI use linked to asthma in kids

Asthma could be considered a potential adverse event of PPI use in children, according to a large Swedish study. The study, comprising 80,870 pairs of children from 0-17 years, found an overall 57% increase in asthma with PPI use.

The risk of asthma was increased in all age groups but was highest in infants <6 months (HR 1.83) and toddlers 6 months – 2 years (HR 1.91). The association between PPI use and asthma was significantly less in children with a history of atopy than those without atopy.

The risk of developing asthma was largely independent of the individual PPI used.

The study concluded PPIs should only be prescribed when clearly indicated, weighing the potential benefit against potential harm.