SESSION TITLE: Pulmonary Vascular Disease Case Report Posters
SESSION TYPE: Affiliate Case Report Poster
PRESENTED ON: Tuesday, October 27, 2015 at 01:30 PM - 02:30 PM
PURPOSE: Oral treprostinil is now approved to treat pulmonary arterial hypertension (PAH). Side effects, such as headache (HA), flushing and jaw pain can limit maximally tolerated TID dose. Herein, we report our initial experience with QID dosing of oral treprostinil.
METHODS: Patients are switched from infusion or inhaled to oral treprostinil TID over a 4 day hospitalization, then further adjusted as outpatient. In 3 patients, side effects limited outpatient uptitration despite significant dyspnea. In a carefully monitored outpatient setting, these patients were switched from TID to QID dosing with RN phone follow-up.
RESULTS: Patient 1 is a 45 year old man with IPAH since 2012 presenting with syncope and functional class (FC) IV symptoms. Treprostinil SQ was started; tadalafil added 3m later; 2 years later 6MWD 515m, FC II. Patient was switched to oral treprostinil 10mg TID 6/2014 due to site pain. Hemodynamics just prior to switch: MPAP 51 mm Hg, PVR 8 Woods units. Dose changed to 8mg QID 10/2014 due to HA, flushing, jaw pain. Dose was uptitrated to 10 mg QID within 3 months, currently FC I. Patient 2 is a 38 year old woman with PAH secondary to late VSD repair, diagnosed 2005, FC II, started on bosentan, tadalafil added 2007, 6MWD 387m. Due to progressive dyspnea, inhaled treprostinil was started 2010, but by 2012 dyspnea had further progressed, FC III, so transitioned to IV treprostinil. Patient was switched to oral treprostinil 10mg TID 9/2014 due to line infection and patient desire. At this time she was FC II, 6MWD 378m, MPAP 41 mm Hg, PVR 4 Woods units. Dose changed to 7mg QID 11/2014 due to HA, flushing, jaw pain then uptitrated to 10mg QID, currently FC II. Patient 3 is a 58 year old man with IPAH diagnosed 2003, FC II, started treprostinil SQ, then bosentan; sildenafil added 2006. Treprostinil SQ was switched to inhaled treprostinil 2010 due to patient’s wishes/active lifestyle; switched to oral treprostinil 2.5mg TID 9/2014 due to patient desire. At this time he was FC II; hemodynamics pre-inhaled treprostinil dose MPAP 60 mm Hg, PVR 16 Woods units; post-inhaled treprostinil dose MPAP 27 mm Hg, PVR 4 Woods units. Dose was uptitrated to 9mg TID due to dyspnea, then changed to 7mg QID due to HA, flushing, jaw pain, currently FC II.
CONCLUSIONS: In this first report of clinical dosing of oral treprostinil QID, we find that it eliminates side effects and allows for higher total daily dose with improved dyspnea and FC.
CLINICAL IMPLICATIONS: QID oral treprostinil offers an effective treatment strategy for PAH.
DISCLOSURE: The following authors have nothing to disclose: Marc Simon, Cheryl Bunner, James Coons, David Ishizawar
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