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Exploring Early Combination Therapy in PAH
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Program Overview
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Assessing Risk of Disease Progression in PAH
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A Multi-Parameter Risk Assessment Is Needed
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Comprehensive Prognostic Evaluation and Risk Assessment
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Risk Assessment in PAH
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Risk Assessment Is Fundamental for Determining an Optimal Treatment Strategy
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Case Example: 25-Year-Old Woman With Heritable PAH*
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2015 ESC/ERS Guidelines: Risk Stratification in PAH
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Mortality in PAH: Prediction by the 2015 European PH Guidelines Risk Stratification Model
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PAH Risk Assessment and Survival in COMPERA
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PAH Risk Assessment and Survival in COMPERA
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Risk Assessment, Prognosis, and Guideline Implementation in PAH
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Risk Assessment and Survival: The French Registry
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Variables Associated With a Higher Risk of Death or Transplantation
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Variables Associated With a Higher Risk of Death or Transplantation (cont)
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Risk Assessment and Survival: The French Registry (cont)
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2015 ESC/ERS Guidelines: Goal of Therapy
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Using the Risk Stratification Table From the ESC/ERS PH Guidelines: Practical Recommendations
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Patient Risk: NYHA FC I/II Is Still Advanced Disease
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Patient Risk: NYHA FC Is Still Advanced Disease (cont)
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AMBITION: Disease Severity at Baseline*
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AMBITION*: Significant Improvement in Outcomes With Initial Ambrisentan + Tadalafil
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AMBITION: Initial Combination Therapy in Patients With FC II or III PAH
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24-Year-Old "Asymptomatic" BMPR 2 Mutation Carrier Diagnosed With PAH During Screening
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24-Year-Old "Asymptomatic" BMPR 2 Mutation Carrier Diagnosed With PAH During Screening (cont)
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24-Year-Old "Asymptomatic" BMPR 2 Mutation Carrier Diagnosed With PAH During Screening (cont)
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PAH Progresses Rapidly in Patients on Monotherapy
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AMBITION: First Adjudicated Clinical Failure by Subgroup
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2015 ESC/ERS Guidelines: Combination Therapy Is Widely Recommended and Supported by Clinical Trial Data
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Hemodynamic Effects of Different Types of Initial Oral Combination Therapy in PAH
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Ambrisentan + Tadalafil: Improved Outcomes With Initial Combination Therapy vs Monotherapy*
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Bosentan + Tadalafil: Improved Outcomes With Initial Combination Therapy vs Monotherapy*
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Initial Dual Oral Combination Therapy: All Regimens Were Associated With Improved HDs
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OPTIMA*: Combination Therapy With Macitentan and Tadalafil Led to Improvements in HDs and FC
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Summary: Treatment Recommendations
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Residual Role of Monotherapy in a Minority of PAH Subsets
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Potential Barriers to Starting Initial Combination Therapy
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AMBITION: AEs Leading to Treatment Discontinuation
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Potential Barriers to Starting Initial Combination Therapy (cont)
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Potential Barriers to Starting Initial Combination Therapy (cont)
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Potential Barriers to Starting Initial Combination Therapy (cont)
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Potential Barriers to Starting Initial Combination Therapy (cont)
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Common AEs of Initial Combination Therapy
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Managing Potential AEs
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Conclusions
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Abbreviations
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Abbreviations (cont)
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Abbreviations (cont)
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Abbreviations (cont)
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