Pulmonary Vascular Disease |

Transitioning From Parenteral to Inhaled Prostacyclin Therapy in Pulmonary Arterial Hypertension: A Single Center Experience FREE TO VIEW

Ali Ataya, MD; Angelina Somoracki; Michael Walker; Jessica Cope; Hassan Alnuaimat, MD
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University of Florida Health, Gainesville, FL

Chest. 2015;148(4_MeetingAbstracts):962A. doi:10.1378/chest.2246442
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SESSION TITLE: Pulmonary Arterial Hypertension Posters II

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: With the introduction of parenteral prostanoids, patients with PAH have experienced significant improvements in functional status, cardiopulmonary function, and quality of life. Long-term parenteral therapies can be cumbersome for patients and carry an increased risk of line-associated complications. Inhalational prostacyclin products are an attractive alternative therapy; however, limited data supporting the safety of transition and the cardiopulmonary function post transition exist.

METHODS: We describe a retrospective observational analysis from August 2011 to August 2014 of adults diagnosed with PAH who were transitioned from a parenteral prostacyclin to inhaled treprostinil at UF Health Shands Hospital. Endpoints include duration of transition, hospital length of stay, adverse effects (ADE) observed during transition, and cardiopulmonary function post transition.

RESULTS: Eight patients were included (age 54±16 yrs, 75% female), all of which were on triple therapy, including an oral ERA and PDE5i. Seven patients receiving intravenous prostacyclin therapy were transitioned in an ICU setting, while one patient was transitioned from subcutaneous treprostinil as an outpatient. Five patients had idiopathic PAH, 1 scleroderma-PAH, 1 drug related-PAH, and 1 congenital heart disease-PAH. Cardiopulmonary parameters were analyzed in all patients prior to transition and in 4 patients post transition. The mean parenteral prostacyclin dose was 22.6±7.7 ng/kg/min prior to transition. The average ICU and hospital length of stay was 4.1±0.7 days. Patient preference was the most common reason for transition (n=5), followed by line complication (n=2), and intolerance to parenteral therapy (n=1). One ADE was observed while initiating inhaled treprostinil (coughing episode) which required slowing of the transition. On follow-up (19.6±11.1 months) hemodynamics and functional class were not significantly different (p>0.05), and non-parametric test showed no change in 6MWD after transition (p=1.0). All statistical tests were tested at α=0.05. One patient failed inhaled therapy necessitating transition back to intravenous epoprostenol.

CONCLUSIONS: Transitioning patients from parenteral to inhaled prostacyclin therapy can be safely accomplished in specialized centers over a 48-72 hour period. Patient preference was overwhelming the most prevalent reason for transition.

CLINICAL IMPLICATIONS: We propose an algorithm that has proven to be safe when transitioning patients from parenteral to inhaled prostacyclin therapy.

DISCLOSURE: The following authors have nothing to disclose: Ali Ataya, Angelina Somoracki, Michael Walker, Jessica Cope, Hassan Alnuaimat

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