• Luke S Howard, Stephan Rosenkranz, Robert P Frantz, Anna R Hemnes, Thomas Pfister, Hsu SchmitzShu-FangSFActelion Pharmaceuticals Ltd, Allschwil, Switzerland., Hall Skåra, Marc Humbert, and Ioana R Preston.
• Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, England. Electronic address: l.howard@imperial.ac.uk.
• Chest. 2023 Feb 1; 163 (2): 407418407-418.

BackgroundReduced daily life physical activity (DLPA) in pulmonary arterial hypertension (PAH) contributes to a poor quality of life.Research QuestionCan actigraphy be used to assess changes in DLPA in patients with PAH receiving selexipag or placebo?Study Design And MethodsEffect of Selexipag on Daily Life Physical Activity of Patients With Pulmonary Arterial Hypertension (TRACE) was a prospective, multicenter, randomized, placebo-controlled, double-blind, exploratory phase 4 study enrolling patients with PAH in World Health Organization functional class II/III, receiving stable endothelin receptor antagonist with/without phosphodiesterase type 5 inhibitor background therapy. Primary end points were change from baseline to Week 24 in actigraphy-assessed DLPA (recorded by using an accelerometer), including daily time spent in nonsedentary physical activity (NSPA), daily time spent in moderate to vigorous physical activity (MVPA), daily volume of activity, and daily number of steps.ResultsAt baseline, patients (N = 108) were prevalent, on stable background PAH therapy, and at low risk of disease progression. Patients showed high compliance with wear of the accelerometer throughout the study. From baseline to Week 24, mean daily time spent in NSPA increased by 1.1 min and decreased by 16.7 min in the selexipag and placebo groups (treatment difference [95% CI], 17.8 [-6.0, 41.6] min); mean time spent in MVPA increased by 0.3 min and was reduced by 2.0 min in the selexipag and placebo groups (treatment difference [95% CI], 2.3 [-10.8, 15.4] min); and mean number of daily steps decreased by 0.3 and 201.9 in the selexipag and placebo groups (treatment difference [95% CI], 201.6 [-243.0, 646.2]).InterpretationTRACE enrolled a prevalent population on background therapy and at low risk of disease progression. Changes in DLPA were small and highly variable, with no statistically significant differences between treatment groups. This patient-centric study was the first randomized trial in PAH to capture high-quality actigraphy data and to describe DLPA in terms of mean/median and variability, which may inform the design of future studies.Clinical Trial RegistrationClinicalTrials.gov; No.: NCT03078907; URL: www.Clinicaltrialsgov.Copyright © 2022 The Author(s). Published by Elsevier Inc. All rights reserved.

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