Exploring patient preferences regarding the use of combination therapy with endothelin receptor antagonist (ERA) + phosphodiesterase-5 inhibitors (PDE5i).

Background: To evaluate patient preferences for endothelin receptor antagonist (ERA) + phosphodiesterase-5 inhibitor (PDE5i) combination therapies in managing pulmonary arterial hypertension (PAH), including the potential benefits of a single tablet combination therapy (STCT) in reducing pill burden and improving adherence. Methods: An online survey was administered to 201 adult patients with PAH residing in the United States. Patients' preferences toward oral PAH therapies, including willingness to use double combination ERA+PDE5i therapy, were assessed using a discrete choice experiment (DCE). Results: Respondents were predominantly White (86.1%) and female (88.6%), with a median age of 59 years. Most were not employed (56.2%), and 38.3% reported a disability. At the time of the survey, 36.8% were on triple therapy (PDE5i + ERA + prostacyclin), 17.9% on dual therapy (PDE5i + ERA), and the remaining on other or no therapy. Out-of-pocket costs and dosing regimen were the top factors influencing therapy choice in the DCE, with patients preferring lower out-of-pocket costs and simpler dosing regimens. Regarding STCT, 83.1% believed it would reduce pill consumption, 68.7% thought it would decrease time spent managing prescriptions, and 34.8% and 39.3% anticipated improvements in treatment initiation and adherence, respectively. Conclusions: STCT offers potential benefits in reducing pill burden, improving convenience, and possibly facilitating treatment initiation and adherence. However, cost remains a significant factor influencing patient decision-making in PAH therapy in the United States. Addressing cost concerns may increase the acceptance of ERA + PDE5i therapies and STCT among patients with PAH.