PURPOSE: Inhaled iloprost is an efficacious prostanoid that avoids well known complications and side effects of IV/SQ prostacyclin therapy. This study evaluated the safety, feasibility, and efficacy of transitioning PAH patients from parenteral to inhaled prostanoid therapy.
METHODS: Retrospective analysis of attempted transitions to inhaled iloprost was carried out at 3 PH centers. When available, information regarding reasons for attempted transitioning, method and duration of transitioning, success of transitioning (defined as at least 3 months off IV/SQ prostacyclin), and clinical status were collected.
RESULTS: A total of 12 attempted transitions occurred. Reasons for transition attempts included intolerable site pain (4), recurrent catheter infections (4), and patient desire (4). 11/12 patients were on concomitant oral PAH therapy prior to initiation of inhaled iloprost (bosentan 7, sildenafil 1, bosentan + sildenafil 4). Duration of the transition period ranged from < 24 hours to 9 weeks. 8 patients were successfully transitioned, with follow-up off IV/SQ PGI2 of between 12 and 52 weeks. Failure occurred both during the transition process (2) and following discontinuation of parenteral prostanoids (2). Reasons for failure of transitioning included hemodynamic worsening (1) and clinical deterioration (3). No deaths occurred during the transition process. In the successful group, follow-up clinical assessments demonstrated maintenence of functional class in all patients (II: 2, III: 5, IV: 1).
CONCLUSION: Attempted transitioning from IV/SQ prostanoids to inhaled iloprost appears safe and feasible in PAH patients. Success of transitioning, however, is variable.
CLINICAL IMPLICATIONS: Transitioning from IV/SQ prostacyclin analogues to inhaled iloprost offers several potential advantages. However, prospective study is needed to confirm the efficacy, safety, and factors predicting success of this approach.
DISCLOSURE: Rajeev Saggar, Grant monies (from industry related sources) 30000; Consultant fee, speaker bureau, advisory committee, etc. 30000.