Riociguat Continuation After Balloon Pulmonary Angioplasty Preserves Exercise Capacity in Inoperable CTEPH: Insights from the THERAPY-HYBRID-BPA Trial

Study background and disease burden

Chronic thromboembolic pulmonary hypertension (CTEPH) is a progressive condition characterized by persistent pulmonary vascular obstruction due to organized thromboemboli, leading to elevated pulmonary arterial pressure, increased pulmonary vascular resistance, and right ventricular dysfunction. Inoperable cases, due to distal lesion location or patient comorbidities, pose a therapeutic challenge. Balloon pulmonary angioplasty (BPA) and medical therapy, particularly riociguat—a soluble guanylate cyclase stimulator—are established treatments; however, the benefit of their combined and continued use post-intervention has not been fully elucidated. Exercise intolerance remains a salient clinical problem despite normalized resting hemodynamics after BPA, underscoring the need for strategies to preserve cardiopulmonary function during exertion. The THERAPY-HYBRID-BPA trial addressed this unmet need by evaluating the impact of continuing versus discontinuing riociguat on exercise capacity and safety in patients with inoperable CTEPH who had undergone BPA and achieved normalized resting pulmonary arterial pressures.

Study design