Effect of First-line Therapy on Survival in Class III IPAH

"The analyses presented demonstrate that starting treatment with bosentan rather than epoprostenol did not adversely affect survival in class III IPAH patients. A prospective comparison of the 2 treatment options would be preferable, but such a study would present considerable design and ethical problems. Although imperfect, this thorough analysis of available data provides our best understanding of the long-term consequences of first-line bosentan therapy, and it is encouraging that results were consistent in all analyses. There was no evidence that first-line treatment with bosentan resulted in any deleterious long-term effect on survival compared with epoprostenol in the patient population analyzed. This gives clinicians comfort in beginning therapy with oral agents in functional class III patients."