PURPOSE: Inhaled iloprost (Ventavis) is approved for pulmonary arterial hypertension (PAH) at a dose of 5 ug 6-9 times per day. The purpose of this study was to determine compliance with the recommend dose, and to determine the safety and efficacy in patients using less than 6 inhalations per day of inhaled iloprost.
METHODS: Fifty-three patients with PAH who began inhaled iloprost between 2002 and 2006 were identified. Telephone interviews were attempted to assess compliance with dosing and adverse effects, and record review for clinical data was performed.
RESULTS: Twenty patients were successfully contacted by telephone and detailed interviews completed. All of these patients were on oral therapy prior to the initiation of iloprost (bosentan 13, bosentan + sildenafil 7). Median duration of iloprost use was 29.5 ± 10.5 weeks. Twelve of 20 patients were using inhaled iloprost at a dose frequency less than 6x/day. Median inhalations for these patients were 4/day. Reasons for less frequent inhalation in all 12 patients were lack of perceived need for more frequent use and lifestyle limitations. Two of the 12 perceived actual increased dyspnea with more frequent use. In this group, no episodes of syncope or clinical worsening were reported. None of the < 6x/day patients required treatments during the nighttime hours. All of these patients were NYHA class III at initiation of iloprost therapy. At the time of telephone interview, 5 of the <6x/day patients had improved to Class II.
CONCLUSION: Inhaled iloprost at a dose frequency less than the recommended 6-9/day is common in PAH patients and is not associated with adverse events or clinically apparent loss of efficacy.
CLINICAL IMPLICATIONS: Prospective studies are needed to confirm that use of inhaled iloprost at a dose frequency of less than 6 x/day is safe and efficacious.
DISCLOSURE: Rajeev Saggar, None.