Pulmonary Hypertension CME ACCREDITED Watch Time: 37 mins

touchEXPERT OPINIONS Treatment decisions for the use of medical therapy in patients with CTEPH

In this activity, watch leading expert Prof. Marc Humbert explore the latest approaches to optimizing clinical management of CTEPH, including medical therapy strategies to better support treatment goals alongside the importance of risk assessment-based treatment decisions. The impact of new and emerging data surrounding use of medical therapies in CTEPH will also be appraised.

Now Playing:
Up Next:
 
Expert Interviews
Meeting treatment goals in patients with CTEPH

Prof. Marc Humbert contextualises current clinical thinking surrounding meaningful and achievable treatment goals in CTEPH to best support near normalization of haemodynamic parameters and functional status, tailored to the individual patient. Options for switching regimens when medical therapies do not meet treatment goals are also explored.

view bio and disclosures
1/3 Next Interview
Take CME Test
Interview Questions

In this interview, Prof. Marc Humbert answers the following questions:

  • What should our treatment goals be?
  • Why is it important to reach individualized treatment goals?
  • Why do so some patients not reach their treatment goals?
  • What are the criteria for switching treatment options in patients not meeting treatment goals?
  • What are the therapeutic options for switching treatment in patients not meeting treatment goals?
 
Risk stratification in CTEPH

Prof. Marc Humbert shares current approaches to assessing risk in patients with CTEPH, including the purpose of risk assessments and implications posed by comorbidities. Learnings from emerging real-world data surrounding the importance of achieving low-risk status for our patients will also be explored.

view bio and disclosures
2/3 Next Interview
Take CME Test
Interview Questions

In this interview, Prof. Marc Humbert answers the following questions:

  • What are the current guidelines for assessing risk in patients with CTEPH?
  • What is the impact of comorbidities on assessing risk?
  • What is the main objective of risk stratification?
  • What do registry studies tell us about the benefits of achieving a low-risk profile?
 
New and emerging data for the use of medical therapy in patients with CTEPH

Prof. Marc Humbert appraises the existing evidence base for switching medical therapy to better support near normalization treatment goals and individual patient needs in CTEPH, notably within the context of pre- and post-surgical treatment options. Emerging real-world evidence surrounding concomitant anticoagulation use is also appraised.

view bio and disclosures
3/3 Take CME Test
Take CME Test
Interview Questions

In this interview, Prof. Marc Humbert answers the following questions:

  • What is the evidence base for switching choice of medical therapy?
  • What is the role for medical therapy in patients with residual PH after surgery?
  • How might combination therapy play a role in patients with inoperable CTEPH?
  • Does medical therapy have a role as a bridging therapy before PEA or BPA?
Take CME Test
Overview & Learning Objectives
Overview

In this activity, watch leading expert Prof. Marc Humbert explore the latest approaches to optimizing clinical management of CTEPH, including medical therapy strategies to better support treatment goals alongside the importance of risk assessment-based treatment decisions. The impact of new and emerging data surrounding use of medical therapies in CTEPH will also be appraised.

This activity has been jointly provided by Oakstone and touchRESPIRATORY. Oakstone Publishing is accredited by the ACCME to provide continuing medical education to physicians.

Target Audience

This activity has been designed to meet the educational needs of pulmonologists, cardiologists, cardiopulmonary surgeons, rheumatologists and other HCPs involved in the care of patients with CTEPH, globally.

Disclosures

Oakstone Publishing has assessed conflict of interest with its faculty, authors, editors, and any individuals who were in a position to control the content of this CME activity. Any identified relevant conflicts of interest were resolved for fair balance and scientific objectivity of studies utilized in this activity. Oakstone Publishing’s planners, content reviewers, and editorial staff disclose no relevant commercial interests.

Faculty

Prof. Marc Humbert discloses: Consultancy/advisory fees from Acceleron, Bayer, GlaxoSmithKline plc, Janssen, Merck Sharp & Dohme.

Content Reviewer

Walter Murray Yarbrough, MD, FACP, has no financial interests/relationships or affiliations in relation to this activity.

Touch Medical Director

Paul Taylor, PhD, has no financial interests/relationships or affiliations in relation to this activity.

Requirements for Successful Completion

Oakstone Publishing designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credit™️.

Physicians should claim only the credit commensurate with the extent of their participation in the activity.

In order to receive credit for this activity, participants must review and complete the post-test and evaluation form. Statements of credit are awarded upon successful completion of the post-test and evaluation form.

The European Union of Medical Specialists (UEMS) – European Accreditation Council for Continuing Medical Education (EACCME) has an agreement of mutual recognition of continuing medical education (CME) credit with the American Medical Association (AMA). European physicians interested in converting AMA PRA Category 1 Credit™ into European CME credit (ECMEC) should contact the UEMS (www.uems.eu)

Date of original release: 17 December 2020. Date credits expire: 17 December 2021.

Learning Objectives

After watching this activity, you should be better able to:

  • Discuss the disease management options for patients with CTEPH whose treatment goals are not met with their current regimen
  • Perform appropriate risk assessments when making treatment decisions for patients with CTEPH
  • Describe the new and emerging data for the use of medical therapy in patients with CTEPH, which can inform treatment decisions
About Prof. Marc Humbert
Prof. Marc Humbert

Professor of Respiratory Medicine, Université Paris-Saclay, Le Kremlin-Bicêtre, France

President-Elect of the European Respiratory Society, Marc Humbert, MD, PhD, is Professor of Respiratory Medicine and Director of the Inserm Unit 999 at the Université Paris-Saclay in Le Kremlin-Bicêtre, France. He is the Director of the Department of Respiratory and Intensive Care Medicine, French Pulmonary Hypertension Reference Centre, Hôpital Bicêtre, Assistance Publique Hôpitaux de Paris, France.

read more

Prof. Marc Humbert was the Chief Editor of the European Respiratory Journal from 2013 to 2017 and he is currently Section Editor in charge of Pulmonary Vascular Medicine. He is a Fellow of the European Respiratory Society (FERS Foundation Fellow) and has received several distinctions including the 2006 Cournand Lecture Award, the 2009 Descartes-Huygens Award from the Royal Netherlands Academy of Arts and Sciences, the 2016 Rare Disease Award of the Fondation de France, the 2018 ERS Award for Lifetime Achievement in Pulmonary Arterial Hypertension, the Excellence 2019 Award from the Fondation du Souffle, and the 2020 American Heart Association’s 3CPR (Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation) Distinguished Achievement Award. Since 2017, Prof. Marc Humbert is the vice-coordinator of the European Reference Network for rare and low prevalence respiratory diseases (ERN-LUNG). Clarivate Analytics listed Marc Humbert as one of the world’s highly cited researchers in the field of Clinical Medicine.

Prof. Marc Humbert discloses: Consultancy/advisory fees from Acceleron, Bayer, GlaxoSmithKline plc, Janssen, Merck Sharp & Dohme.

Downloads

View and download resources from this activity to support your learning or share with colleagues.

CME Test (0.5 Points) Close
CME Test

To obtain the CME credit(s) please complete this post-test. Please complete and click to see your results and continue.

Question 1/5
Which of the following is correct regarding achieving and maintaining treatment goals in patients with CTEPH?
Correct

Analysis of a French registry showed that achieving one or more low-risk criteria was associated with a reduction in both the risk of death and clinical worsening over two years compared with achieving no low-risk criteria. Analysis of a Swedish registry showed that patients stratified as low risk at week 16 had a decreased risk of death or clinical worsening compared with those in the intermediate-risk stratum.

CTEPH, chronic thromboembolic pulmonary hypertension; PH, pulmonary hypertension.

Reference:
Humbert M, et al. Eur Respir J. 2019;53:1802004

Question 2/5
The International CTEPH Registry reported how many patients with CTEPH were deemed inoperable due to comorbidities?
Correct

The International CTEPH Registry reported 13.4% (33/247) of recorded patients with inoperable CTEPH were deemed inoperable due to comorbidities.

CTEPH, chronic thromboembolic pulmonary hypertension.

Reference:
Pepke-Zaba J, et al. Circulation. 2011;124:1973–81.

Question 3/5
In the CAPTURE real-world study, what percentage of patients with inoperable or persistent/recurrent CTEPH switched from PDE5i to riociguat due to lack of efficacy?
Correct

The CAPTURE real-world study reported that 71% of patients with CTEPH switched to riociguat monotherapy.

CTEPH, chronic thromboembolic pulmonary hypertension; PDE5i, phosphodiesterase type 5 inhibitor.

Reference:
Gall, H et al. Lung. 2018;196:305–12.

Question 4/5
Considering the definitions of ‘unsatisfactory response’ to prior therapy from the RESPITE and REPLACE clinical studies which of the following would you consider an inadequate response to prior therapy in your patient with CTEPH?
Correct

Using the RESPITE and REPLACE definitions, a patient with WHO FC III and a 6MWD of 165–440 m is deemed to have an ‘unsatisfactory response’ to prior therapy.

CTEPH, chronic thromboembolic pulmonary hypertension; RAP, right atrial pressure; WHO FC, World Health Organization functional class.

References:
Benza RL, et al. Pulm Circ. 2020;10:1–12.

Question 5/5
For your patient with CTEPH and residual PH post-PEA, what mPAP threshold should you consider initiating medical therapy?
Correct

Analysis of 880 consecutive patients who underwent PEA for CTEPH suggested that 30 mmHg is a plausible threshold, and, therefore, patients with an mPAP ≥30 mm Hg were at risk of a deteriorating functional status, which triggered pulmonary vasodilator therapy initiation.

CTEPH, chronic thromboembolic pulmonary hypertension; mPAP, mean pulmonary arterial pressure; PEA, pulmonary endarterectomy.

References:
Cannon JE, et al. Circulation. 2016;133:1761–71.

Post Test Feedback Close
Step 1: Post CME Test Feedback

Please note this feedback form is compulsory to complete your CME evaluation

Please complete this short online feedback form.
Please indicate how well each statement met your expectations.

Accreditation Close
Accreditation

Please provide your details so that we can send you your certificate, which will be emailed to the address provided. All fields are required.

Your Accreditation Close
Copied to clipboard!
accredited arrow-down-editablearrow-downarrow_leftarrow-right-bluearrow-right-dark-bluearrow-right-greenarrow-right-greyarrow-right-orangearrow-right-whitearrow-right-bluearrow-up-orangeavatarcalendarchevron-down consultant-pathologist-nurseconsultant-pathologistcrosscrossdownloademailexclaimationfeedbackfiltergraph-arrowinterviewslinkmdt_iconmenumore_dots nurse-consultantpadlock patient-advocate-pathologistpatient-consultantpatientperson pharmacist-nurseplay_buttonplay-colour-tmcplay-colourAsset 1podcastprinter scenerysearch share single-doctor social_facebooksocial_googleplussocial_instagramsocial_linkedin_altsocial_linkedin_altsocial_pinterestlogo-twitter-glyph-32social_youtubeshape-star (1)tick-bluetick-orangetick-red tick-whiteticktimetranscriptup-arrowwebinar Department Location NEW TMM Corporate Services Icons-07NEW TMM Corporate Services Icons-08NEW TMM Corporate Services Icons-09NEW TMM Corporate Services Icons-10NEW TMM Corporate Services Icons-11NEW TMM Corporate Services Icons-12Salary £ TMM-Corp-Site-Icons-01TMM-Corp-Site-Icons-02TMM-Corp-Site-Icons-03TMM-Corp-Site-Icons-04TMM-Corp-Site-Icons-05TMM-Corp-Site-Icons-06TMM-Corp-Site-Icons-07TMM-Corp-Site-Icons-08TMM-Corp-Site-Icons-09TMM-Corp-Site-Icons-10TMM-Corp-Site-Icons-11TMM-Corp-Site-Icons-12TMM-Corp-Site-Icons-13TMM-Corp-Site-Icons-14TMM-Corp-Site-Icons-15TMM-Corp-Site-Icons-16TMM-Corp-Site-Icons-17TMM-Corp-Site-Icons-18TMM-Corp-Site-Icons-19TMM-Corp-Site-Icons-20TMM-Corp-Site-Icons-21TMM-Corp-Site-Icons-22TMM-Corp-Site-Icons-23TMM-Corp-Site-Icons-24TMM-Corp-Site-Icons-25TMM-Corp-Site-Icons-26TMM-Corp-Site-Icons-27TMM-Corp-Site-Icons-28TMM-Corp-Site-Icons-29TMM-Corp-Site-Icons-30TMM-Corp-Site-Icons-31TMM-Corp-Site-Icons-32TMM-Corp-Site-Icons-33TMM-Corp-Site-Icons-34TMM-Corp-Site-Icons-35TMM-Corp-Site-Icons-36TMM-Corp-Site-Icons-37TMM-Corp-Site-Icons-38TMM-Corp-Site-Icons-39TMM-Corp-Site-Icons-40TMM-Corp-Site-Icons-41TMM-Corp-Site-Icons-42TMM-Corp-Site-Icons-43TMM-Corp-Site-Icons-44TMM-Corp-Site-Icons-45TMM-Corp-Site-Icons-46TMM-Corp-Site-Icons-47TMM-Corp-Site-Icons-48TMM-Corp-Site-Icons-49TMM-Corp-Site-Icons-50TMM-Corp-Site-Icons-51TMM-Corp-Site-Icons-52TMM-Corp-Site-Icons-53TMM-Corp-Site-Icons-54TMM-Corp-Site-Icons-55TMM-Corp-Site-Icons-56TMM-Corp-Site-Icons-57TMM-Corp-Site-Icons-58TMM-Corp-Site-Icons-59TMM-Corp-Site-Icons-60TMM-Corp-Site-Icons-61TMM-Corp-Site-Icons-62TMM-Corp-Site-Icons-63TMM-Corp-Site-Icons-64TMM-Corp-Site-Icons-65TMM-Corp-Site-Icons-66TMM-Corp-Site-Icons-67TMM-Corp-Site-Icons-68TMM-Corp-Site-Icons-69TMM-Corp-Site-Icons-70TMM-Corp-Site-Icons-71TMM-Corp-Site-Icons-72