PURPOSE: To assess safety and viability of rapid transition from intravenous prostaglandin to inhaled Iloprost (Ventavis™) in a controlled and monitored environment.
METHODS: Two patients with pulmonary arterial hypertension being maintained in NYHA class 11, on intravenous prostaglandin therapy, due to multiple line infections requested transition to Ventavis™. This was achieved in the in-patient setting over 96 hours. Twenty five percent down titration of intravenous prostaglandin was done each day. Ventavis™ was initiated at 2.5 mcg inhaled dose three times daily on the first day, increased to 5mcg three times daily on the second day, four time daily on the third day and on fourth day six times daily. Constant monitoring of hemodynamics, ECG and pulse oximetery were done throughout their hospital stay. Data was collected and monitored Pre, post-transition, at one and three months . Symptoms along with, right ventricular systolic pressures (RVSP), right ventricular chamber size and six-minute walk were assessed.
RESULTS: RESULTS: The first patient was on intravenous epoprostenol of 60ng/Kg/min, had RVSP, RV chamber size and six-minute walk of 70mmHg, 3.09cm and 1100 feet at the time of transition. Immediately after they were 68mmHg, 3.1cm and 1200 feet respectively. Six-minute walk at one and three months was 1200 and 1100 feet. The Second patient was on intravenous treprostinil of 80ng/Kg/min. had RVSP, RV chamber size and six-minute walk of 64mmHg, 3.5cm and 1300 feet at the time of transition and immediately after were 72mmHg, 3.44cm and 1190 feet respectively. Six-minute walk at one and three months was 1040 and 1330 feet. Functional class and symptoms severity remained same through out.
CONCLUSION: In patients with pulmonary arterial hypertension, who are on intravenous prostaglandin, rapid transition to inhaled Iloprost can be safely done, without adversely affecting their pulmonary pressures or functional class.
CLINICAL IMPLICATIONS: Compared to long outpatient initiated transition, rapid in-patient transition eliminates the uncertainty and ambiguity associated with it, in terms of patient assessment and monitoring.
DISCLOSURE: Ramagopal Tumuluri, Consultant fee, speaker bureau, advisory committee, etc. CoTherix, Pfizer, Abbott.