Pulmonary Circulation 2020; 10(1) 1-7

DOI: 10.1177/2045894019876545

Date received: 10 June 2019; accepted: 12 August 2019

ãThe Author(s) 2020

Hemodynamic and clinical effects of selexipag in children with pulmonary hypertension

Author

Abraham Rothman, MD, Gabriel Cruz, William N. Evans, MD, Humberto Restrepo, MD, MPH

Source

Abraham Rothman, Children’s Heart Center Nevada, 3006 S. Maryland Pkwy,

Ste 690, Las Vegas NV 89109, USA.

Abstract

Selexipag is an oral prostacyclin receptor agonist; it was recently approved for use in adults with pulmonary arterial hypertension.

The safety and efficacy of selexipag has not yet been determined in the pediatric population.We describe short-term hemodynamic

and clinical data with selexipag therapy in four pediatric patients with pulmonary hypertension. We reviewed clinical, echocardiographic,

and hemodynamic data. One patient was transitioned from subcutaneous treprostinil to selexipag, and in three patients,

selexipag was added as a third agent. Drug dosing was attained empirically based on patient body size. A follow-up catheterization

was performed 12–18 months after initiation of selexipag therapy. All four patients tolerated selexipag well, without significant side

effects. One patient transitioned successfully from subcutaneous treprostinil to selexipag. None of the four patients had clinical

deterioration. In three patients who were able to perform a 6-minute walk test, pre and post selexipag distances were 350 and 400,

409 and 390, and 300 and 360 m, respectively. Echocardiograms showed no significant changes. Catheterization showed a variable

change in pulmonary vascular resistance (small decrease in three patients and increase in one patient). Brain natriuretic peptide

levels before and after selexipag in the four patients were 38 and 49, 33 and 54, 29 and 25, and 12 and 14 pg/mL, respectively.

Selexipag use for 16–28 months was safe in four pediatric patients; none of them had clinical deterioration. Larger number of

patients and longer follow-up intervals are necessary before further recommendations can be made.