The underutilization of the prostacyclin route. What place does Selexipag occupy?

Abstract

Pulmonary arterial hypertension (PAH) is a rare disease with a late diagnosis, but it has changed in recent years from being an ominous disease in the short term, to one with a serious prognosis, but greater survival. The advances in physiopathology led to the development of drugs that have impacted on outcome. Three main pathways have been identified. The endothelin one, with vasoconstrictive properties, and other two vasodilators pathways: the nitric oxide and the prostacyclines. The available prostaglandin analog drugs are epoprostenol, treprostinil, iloprost and beraprost. Selexipag, an agonist of the prostaglandin I2 receptor, which specifically activates the IP receptor, has recently been incorporated. This review evaluates the role of these drugs in
the management of PAH, the existing barriers to their use and the expected role of selexipag in overcoming this deficit. Prostacycline pathway has been the least used and the main reasons include treating physicians, the lack of referral to specific centers, side effects, complications associated with administration routes, errors in their use, titration problems and costs. The selexipag, unlike the rest, has better chemical and biological stability, with an oral route of administration and greater receptor selectivity, with solid clinical evidence, which positions it as a valid alternative to expanding its earlier prescription to patients of intermediate to high risk, with the aim of reducing morbidity and mortality.