Improved cardiac function and quality of life with initial macitentan-tadalafil combination therapy compared to tadalafil alone in pulmonary arterial hypertension.

OBJECTIVES: Pulmonary arterial hypertension (PAH) is a progressive disease leading to right ventricular failure. The purpose of this study was to evaluate the effects of macitentan combined with tadalafil versus tadalafil monotherapy on cardiac function and quality of life (QOL) in PAH patients. METHODS: This retrospective analysis involved patients identified with PAH who commenced regular therapy between April 2024 and April 2025. Participants were divided into two groups according to their treatment regimen: tadalafil monotherapy (TM) and macitentan combined with tadalafil (MCT). Hemodynamic values, laboratory biomarkers, exercise capacity, and patient-reported outcomes were assessed at baseline and after 6 months of treatment. RESULTS: In total, 217 patients were analyzed (TM group: 114; MCT group: 103). After 6 months, the MCT group demonstrated significantly greater improvements in mean pulmonary arterial pressure (38.73 vs. 40.31 mmHg, P=0.029), cardiac index (2.93 vs. 2.61 L/min/m2, P<0.001), N-terminal pro-B-type natriuretic peptide (997.14 vs. 1058.20 fmol·ml-1, P=0.034) and pulmonary vascular resistance (685.35 vs. 736.83 dyn·sec/cm5, P=0.001) compared to the TM group. The MCT group also showed a longer 6-minute walk distance (422.27 vs. 387.94 m, P=0.013) and lower Pulmonary Arterial Hypertension Symptoms and Impact Questionnaire symptom scores (0.84 vs. 0.95, P<0.001). Safety profiles were similar between groups (all P>0.05). CONCLUSIONS: Initial combination therapy with macitentan and tadalafil provides superior hemodynamic, functional, and QOL benefits compared to tadalafil monotherapy in patients with PAH.