Clinical and hemodynamic benefit of macitentan and riociguat upfront combination in patients with pulmonary arterial hypertension.

9 , 10 The Ambrisentan and Tadalafil in Patients with Pulmonary Arterial Hypertension (AMBITION) trial is the first randomized controlled trial of initial dual combination therapy, and showed a highly significant reduction in the risk of clinical failure for patients on upfront dual therapy as compared with the pooled monotherapy arm. 11 This clinical trial did not, however, include hemodynamic data, and it is currently unknown if this is a class effect, and if similar results might be obtained by substituting the respective agents with other compounds from the respective class.

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