PURPOSE: Treprostinil is a prostacyclin analog available in inhaled, subcutaneous and intravenous forms. This study investigated the rationale, safety, and tolerability of transition from inhaled to parenteral treprostinil in pulmonary arterial hypertension (PAH).
METHODS: Observational study from 5 PH Centers. Demographics, methods of transition and characteristics before and after transition were recorded. Results are average and standard deviations.
RESULTS: Nine patients (6 females) aged 63±9.8 years were included: idiopathic PAH (2 patients), connective tissue disease-PAH (3 patients), portopulmonary hypertension, chronic thromboembolic-PH, PAH associated with sarcoidosis, and POEMS (1 each). They received inhaled treprostinil for 8±6.6 months before transition, inhaling 58±8 mcg 4 times/day while on phosphodiesterase 5 inhibitors (7 patients) or endothelin receptor antagonists (2 patients). Five had clinical deterioration and 4 inadequate response. In 8 patients right heart catheterization prior to transition showed severe PAH. Transition was carried out in hospital (6 patients), outpatient (2), or home (1). Four patients were transitioned to intravenous and 5 to subcutaneous treprostinil. In 5 patients inhaled treprostinil was down titrated while parenteral drug was uptitrated over several days. In 4 patients, inhaled therapy was stopped and infusion was started at 2-4 ng/kg/min (in 3 patients transition occurred the same day). Patients were followed 5.2±6 months. Treprostinil dose at last follow up was 26±11ng/kg/min. Two patients died after 2.7 and 6.8 months of metastatic carcinoid with pulmonary embolism and pulmonary embolism, respectively and one underwent lung transplantation after 10 months of intravenous therapy. Six patients continue to be on parenteral treprostinil. Functional class improved or was maintained (2.8±0.6 to 2.6±0.5) and brain natriuretic peptide improved in most patients tested at first assessment post-transition. Transition was well tolerated.
CONCLUSIONS: In selected PAH patients who did not respond or deteriorated on inhaled treprostinil, transition to parenteral treprostinil can be done safely in both inpatient and outpatient settings.
CLINICAL IMPLICATIONS: This retrospective study suggests that in selected PAH patients changing one form of prostacyclin delivery to another can be done safely.
DISCLOSURE: Ioana Preston: Grant monies (from industry related sources): Actelion, Bayer, Gilead, Pfizer, United Therapeutics, Consultant fee, speaker bureau, advisory committee, etc.: Actelion, Bayer, Gilead, Pfizer, United Therapeutics
Aaron Waxman: Grant monies (from industry related sources): United Therapeutics
James White: Grant monies (from industry related sources): Actelion, Gilead, United Therapeutics, Consultant fee, speaker bureau, advisory committee, etc.: Gilead, United Therapeutics
Nicholas Hill: Grant monies (from industry related sources): Actelion, Bayer, Gilead, Pfizer, United Therapeutics
The following authors have nothing to disclose: David Ishizawar, Charles Burger
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