2 , 90 – 94 Various sequential combination strategies of ERAs, PDE-5 inhibitors, and prostanoids have been used, with mixed success, but an overall trend has supported this strategy in patients who do not respond to initial monotherapy. 2 , 95 There has been a recent change in this paradigm with the AMBITION study in 2015, in which patients treated with initial combination of ambristentan and tadalafil had improvement in a composite endpoint of deat
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33 They also found that the mean placebo-adjusted treatment response among whites was increase in 6WMD by 41.5 m, whereas in blacks 6WMD decreased by 3.5 m, though this finding did not quite reach statistical significance, owing to the small number of blacks enrolled in the trials. 33 This is an important finding that could impact the treatment of PAH patients and selection of initial therapy, and further suggests the possibility of genetic or hormonal differences playing a role in response to these drugs.