PURPOSE:Transition from intravenous epoprostenol (epo) to subcutaneous treprostinil (tre) has been reported to be feasible and safe in patients with PAH (Chest 2002; 121: 1561–5). However, the long-term outcome after transition has never been examined.
METHODS:Multicenter retrospective chart review. Data presented as mean ± SEM. Epo and tre doses are ng/kg/min.
RESULTS:Of 30 enrolled patients (23 female, age 49 ± 2.7 years), 14 had idiopathic PAH, 14 had PAH-associated conditions and 2 had chronic thromboembolic PH. Reason for transition was catheter-related complications (n=15), prostacyclin-related side effects (n=6) and convenience of a less-invasive therapy (n=9). Mean epo dose before transition was 29.7±3.5. Mean tre dose after transition, 3 and 5 years was 39.2 ± 8.2, 64.2 ± 11.6 [14 to 188] (n=16) and 48.3 ± 12.4 [16 to 76] (n=4) respectively. During the same time period, six minute walk distances (6MWD) were 378.4 ± 29.1 m, 431.1 ± 25.4 m and 533.8 ± 63.4 m, Borg dyspnea scores 5.2 ± 1.0, 5.5 ± 0.8 and 5.3 ± 1.5 and NYHA class 2.4 ± 0.2, 2.3 ± 0.2 and 2 ± 0.0, respectively. After a mean tre duration of 29 months ±23 (median 23), 11 patients remain on tre, 3 underwent transplantation and 8 died (1 after transplant). Nine patients discontinued tre, 6 related to side effects and 3 who did well on tre and were transitioned to oral agents.
CONCLUSION:Transition from epo to tre is safe with patients maintaining a favorable long term 6MWD and NYHA class. However, discontinuation rate secondary to side effects and mortality remains high.
CLINICAL IMPLICATIONS:Transition is safe and can maintain long-term stability in some PAH patients.
DISCLOSURE:Cynthia Yan, Grant monies (from industry related sources) Grant Support from Actelion, Encysive, Gilead, Lilly, Pfizer, United Therapeutics (Drs. Preston, Hill).; Consultant fee, speaker bureau, advisory committee, etc. Advisory Board/Speakers Bureau: Actelion, Gilead, Encysive, United Therapeutics (Drs. Preston, Hill).Advisory Board/Speakers Bureau: Actelion Pharmaceuticals, Advisory Board: Gilead Pharmaceuticals (Dr. Soto).; No Product/Research Disclosure Information