title: Use of selective serotonin reuptake inhibitors and outcomes in pulmonary arterial hypertension.
abstract: BACKGROUND
  Selective serotonin reuptake inhibitors (SSRIs) have been suggested to offer therapeutic benefit in patients with pulmonary arterial hypertension (PAH). We conducted two analyses to explore the association between SSRI use and PAH outcomes using the Registry to Evaluate Early and Long-term PAH Disease Management (REVEAL Registry).
  
  
  METHODS
  First, new users (SSRI-naive patients who initiated treatment after enrollment, incident use analysis, n = 220) were matched (1:2) with non-SSRI users (nonusers, n = 440) by enrollment center, sex, date of most recent visit, age, and 6-min walk distance. Second, a cross-sectional design was used to compare nonusers (n = 2,463), high-affinity SSRI users (n = 430), and non-high-affinity SSRI users (n = 125) at enrollment. Mortality and a composite end point defined by events indicative of clinical worsening were evaluated.
  
  
  RESULTS
  New users had a higher risk of death (unadjusted hazard ratio [HR], 1.74; 95% CI, 1.19-2.54; P = .004) and were less likely to be free from the composite end point 2 years after enrollment vs nonusers (25.7% vs 43.2%, respectively; P &lt; .001). Similarly, among prevalent SSRI users (patients with a history of SSRI use at enrollment), high-affinity SSRI users were less likely to be free from the composite end point vs nonusers (unadjusted HR, 1.20; 95% CI, 1.07-1.36; P = .003). In both analyses, differences in outcome were maintained after adjustment for clinical variables previously associated with PAH outcomes.
  
  
  CONCLUSIONS
  In a large population of patients with PAH, incident SSRI use was associated with increased mortality and a greater risk of clinical worsening, although we could not adjust for all potential confounders.
authors.affiliation: Department of Medicine, Hofstra-North Shore LIJ School of Medicine, New Hyde Park, NY.
authors.forename: Ali
authors.initials: A
authors.lastname: Sadoughi
authors.affiliation: Department of Medicine, Tufts Medical Center, Boston, MA.
authors.forename: Kari E
authors.initials: KE
authors.lastname: Roberts
authors.affiliation: Department of Medicine, Tufts Medical Center, Boston, MA.
authors.forename: Ioana R
authors.initials: IR
authors.lastname: Preston
authors.affiliation: ICON Late Phase & Outcomes Research, San Francisco, CA.
authors.forename: Ginny P
authors.initials: GP
authors.lastname: Lai
authors.affiliation: University of Colorado Denver, Denver, CO.
authors.forename: Deborah H
authors.initials: DH
authors.lastname: McCollister
authors.affiliation: Department of Medicine, Boston University School of Medicine, Boston, MA.
authors.forename: Harrison W
authors.initials: HW
authors.lastname: Farber
authors.affiliation: Department of Medicine, Tufts Medical Center, Boston, MA. Electronic address: nhill@tuftsmedicalcenter.org.
authors.forename: Nicholas S
authors.initials: NS
authors.lastname: Hill
mesh_terms: D015986:Confounding Factors, Epidemiologic; D003430:Cross-Sectional Studies; D065627:Familial Primary Pulmonary Hypertension; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy* / Q000401:mortality; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012042:Registries; D012307:Risk Factors; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D017367:Selective Serotonin Reuptake Inhibitors
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