Rapid Transition from Inhaled Iloprost to Inhaled Treprostinil in Patients with Pulmonary Arterial Hypertension

Overview

Journal Cardiovasc Ther

Publisher Hindawi

Date 2012 Sep 14

PMID 22970909

Citations 18

Authors

Robert C Bourge

Victor F Tapson

Zeenat Safdar

Raymond L Benza

Richard N Channick

Erika B Rosenzweig

Shelley Shapiro

R James White

Christopher Shane McSwain

Stephen Karl Gotzkowsky

Andrew C Nelsen

Lewis J Rubin

Affiliations

Soon will be listed here.

Abstract

Background: Inhaled treprostinil is a prostacyclin analog approved for the treatment of pulmonary arterial hypertension (PAH) that may provide a more convenient treatment option for patients receiving inhaled iloprost while maintaining the clinical benefit of inhaled prostacyclin therapy.

Aims: In this open-label safety study, 73 PAH patients were enrolled with primarily World Health Organization Class II (56%) or III (42%) symptoms. At baseline, most patients (93%) were receiving 5 μg of iloprost per dose but 38% of patients reported a dosing frequency below the labeled rate of 6-9 times daily. Patients initiated inhaled treprostinil at 3 breaths four times daily (qid) at the immediate next scheduled iloprost dose. The primary objective was to assess the safety of rapid transition from iloprost to inhaled treprostinil; clinical status and quality of life were also assessed.

Results: Most patients (84%) achieved the target treprostinil dose of 9 breaths qid and remained on study until transition to commercial therapy (89%). The most frequent adverse events (AEs) were cough (74%), headache (44%), and nausea (30%), and five patients prematurely discontinued study drug due to AE (n = 3), disease progression (n = 1), or death (n = 1). At week 12, the time spent on daily treatment activities was reduced compared to baseline, with a mean total savings of 1.4 h per day. Improvements were also observed at week 12 for 6-min walk distance (+16.0; P < 0.001), N-terminal pro-B-type natriuretic peptide (-74 pg/mL; P = 0.001), and the Cambridge Pulmonary Hypertension Outcome Review (all domains P < 0.001).

Conclusions: Pulmonary arterial hypertension patients can be safely transitioned from inhaled iloprost to inhaled treprostinil while maintaining clinical status.

Citing Articles

Efficacy, safety, and pharmacokinetics of inhaled treprostinil in Japanese patients with pulmonary arterial hypertension.

Kuwana M, Abe K, Kinoshita H, Matsubara H, Minatsuki S, Murohara T Pulm Circ. 2023; 13(1):e12198.

PMID: 36788940 PMC: 9906001. DOI: 10.1002/pul2.12198.

Inhaled treprostinil vs iloprost: Comparison of adherence, persistence, and health care resource utilization in patients with pulmonary arterial hypertension.

Burger C, Wu B, Classi P, Morland K J Manag Care Spec Pharm. 2022; 29(1):101-108.

PMID: 36580122 PMC: 10387966. DOI: 10.18553/jmcp.2023.29.1.101.

The Transition From Ambrisentan to Macitentan in Patients With Pulmonary Arterial Hypertension: A Real-word Prospective Study.

Chen Y, Luo J, Chen J, Kotlyar E, Li Z, Chen W Front Pharmacol. 2022; 12:811700.

PMID: 35095523 PMC: 8790043. DOI: 10.3389/fphar.2021.811700.

Inhaled pulmonary vasodilators: a narrative review.

Liu K, Wang H, Yu S, Tu G, Luo Z Ann Transl Med. 2021; 9(7):597.

PMID: 33987295 PMC: 8105872. DOI: 10.21037/atm-20-4895.

Bronchodilation induced by PGE is impaired in Group III pulmonary hypertension.

Ozen G, Benyahia C, Mani S, Boukais K, Silverstein A, Bayles R Br J Pharmacol. 2019; 177(1):161-174.

PMID: 31476020 PMC: 6976782. DOI: 10.1111/bph.14854.

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