0
Original Research: PULMONARY HYPERTENSION |

Efficacy of Long-term Subcutaneous Treprostinil Sodium Therapy in Pulmonary Hypertension*

Irene Lang, MD, PhD; Miguel Gomez-Sanchez, MD; Meinhard Kneussl, MD, PhD; Robert Naeije, MD, PhD; Pilar Escribano, MD; Nika Skoro-Sajer, MD; Jean-Luc Vachiery, MD
Author and Funding Information

*From the Departments of Cardiology (Drs. Lang and Skoro-Sajer) and Pulmonology (Dr. Kneussl), Vienna General Hospital and Medical University of Vienna, Austria; Cardiology Department (Drs. Gomez-Sanchez and Escribano), Hospital Doce de Octubre, Madrid, Spain; and Department of Cardiology (Drs. Naeije and Vachiery), Hôpital Erasme, Bruxelles, Belgium.

Correspondence to: Jean-Luc Vachiery, MD, Department of Cardiology, Hôpital Erasme, Route de Lennik 808, B-1070 Bruxelles, Belgium; e-mail: jean-luc.vachiery@ulb.ac.be



Chest. 2006;129(6):1636-1643. doi:10.1378/chest.129.6.1636
Text Size: A A A
Published online

Study objectives: The aim of this long-term multicenter analysis was to investigate whether subcutaneously infused treprostinil could provide sustained improvements of exercise capacity and survival benefits in patients with pulmonary arterial hypertension (PAH) and inoperable chronic thromboembolic pulmonary hypertension (CTEPH). Subcutaneous administration of the prostacyclin analog treprostinil is an effective treatment for PAH that, unlike epoprostenol, does not require the insertion of a permanent central venous catheter.

Design: Multicenter retrospective study.

Setting: Three European university hospitals.

Methods: Ninety-nine patients with PAH and 23 patients with CTEPH in New York Heart Association (NYHA) classes II-IV were followed up for a mean of 26.2 ± 17.2 months (± SE) [range, 3 to 57 months]. Long-term efficacy was assessed by 6-min walking distance (SMWD), Borg dyspnea score, and NYHA class. Clinical events were monitored to assess survival and event-free survival.

Results: At 3 years, significant improvements from baseline were observed in mean SMWD (305 ± 11 to 445 ± 12 m, p = 0.0001), Borg dyspnea score (5.7 ± 0.2 to 4.5 ± 1, p = 0.0006), and NYHA class (3.20 ± 0.04 to 2.1 ± 0.1, p = 0.0001). These changes were observed under a mean dose of subcutaneously infused treprostinil at 40 ± 2.6 ng/kg/min (range, 16 to 84 ng/kg/min). Subcutaneously infused treprostinil was well tolerated, and local pain at the subcutaneous site accounted for treatment interruption in only 5% of the cases. Survival was 88.6% and 70.6% at 1 year and 3 years, respectively. At the same time points, the event-free survival rates, defined as survival without hospitalization for clinical worsening, transition to IV epoprostenol, and need for combination therapy or atrial septostomy, were 83.2% and 69%, respectively.

Conclusions: Long-term subcutaneous therapy with treprostinil appears to continuously improve exercise tolerance and symptoms in patients with PAH and inoperable CTEPH. Moreover, treatment may provide a significant survival benefit.

Figures in this Article

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

CHEST Journal Articles
PubMed Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543