Switching to riociguat versus maintenance therapy with phosphodiesterase-5 inhibitors in patients with pulmonary arterial hypertension (REPLACE): a multicentre, open-label, randomised controlled trial

RCT (n=226) found that switching to riociguat vs. continued PDE5i therapy (both agents act via nitric oxide–soluble guanylate cyclase–cyclic guanosine monophosphate pathway) could be a strategic option for treatment escalation in patients at intermediate risk of 1-year mortality.

SPS commentary:

In the study, the primary endpoint of improvement by week 24, defined as an absence of clinical worsening and prespecified improvements in at least two of three variables (6MWD, WHO functional class, and N-terminal prohormone of brain natriuretic peptide), was met by 45 (41%) patients in the riociguat group and 23 (20%) in the PDE5i group (OR 2.78; 95% CI 1.53–5.06; p=0.0007).

The Lancet Respiratory Medicine