Adding a third agent to therapy can offer meaningful early benefits for patients with pulmonary arterial hypertension (PAH). Findings presented at the European Society of Cardiology (ESC) Congress 2025 explored the use of an oral IP receptor agonist in triple sequential therapy for PAH, evaluating its long-term effectiveness and tolerability.

Published in the European Heart Journal, this single-center study analyzed 128 patients (mean age 43 years, 84% female) receiving selexipag-based triple therapy. Clinical, echocardiographic, and hemodynamic measures were tracked over a median follow-up of two years.

Within the first year, patients showed significant improvement in functional class, six-minute walk distance, and right ventricular performance. However, these benefits diminished thereafter, suggesting an attenuation of efficacy over time. Mortality was linked to baseline risk scores such as SPAHR and REVEAL 2.0, but not to selexipag dosage or early response.

These findings support the use of oral IP receptor agonist–based triple therapy as an effective option in PAH management, with close monitoring warranted beyond the first treatment year.