Trepostinil (TRE), a prostacyclin analog administered as a continuous subcutaneous infusion, is a safe and effective alternative to intravenous epoprostenol (EPO) in the treatment of pulmonary arterial hypertension (PAH). We reported the successful transitioning from EPO to TRE in an intensive care unit (ICU). This study implemented a protocol for stable outpatients on EPO.
Stable PAH patients receiving treatment with intravenous EPO were transitioned to subcutaneous TRE. Twelve patients electively chose to transition, one patient secondary to recurrent central line sepsis, and one due to severe migraine headaches secondary to EPO. Eleven of fourteen transitions were completed without cardiac monitoring on a telemetry unit. The remaining 3 transitions occurred in a rehabilitation facility, an ICU, and an outpatient department.
Fourteen patients (10 female/4 male) received EPO for an average of 19.6 months prior to transitioning. Mean age was 45.7 years. Six patients had primary pulmonary hypertension. The causes of secondary PAH were connective tissue disease (n=6), mitral stenosis (n=1) and portopulmonary hypertension (n=1). EPO dose ranged from 4 to 86 ng/kg/min (mean=31 ng/kg/min). The dose of TRE at completion of the transition ranged from 4 to 62 ng/kg/min (mean=29 ng/kg/min). The average time to complete the transitioning protocol was 2.6 days (range=2 hours-5 days). Prior to the transition, 1 patient was classified as WHO functional class IV, 4 were classified as functional class III, 3 were classified as functional class II, and 6 patients were classified as functional class I. After transition and stabilization (6 months of TRE), no patients were classified as functional class IV, 1 was classified as functional class III, 6 were classified as functional class II, and 7 patients were classified as functional class I. No patients required the reinstitution of EPO.
Safe and cost-efficient transitioning of stable patients from intravenous EPO to subcutaneous TRE can be accomplished in non-ICU settings.
Stable outpatient EPO to TRE patient transitions can be completed on a telemetry unit or in an outpatient department.
D.L. Zwicke, United Therapeutics, Inc.