Rapid transition from inhaled iloprost to inhaled treprostinil in patients with pulmonary arterial hypertension

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. In this open-label saf...

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Bibliographic Details
Published in:	Cardiovascular therapeutics Vol. 31; no. 1; p. 38
Main Authors:	Bourge, Robert C, Tapson, Victor F, Safdar, Zeenat, Benza, Raymond L, Channick, Richard N, Rosenzweig, Erika B, Shapiro, Shelley, White, R James, McSwain, Christopher Shane, Gotzkowsky, Stephen Karl, Nelsen, Andrew C, Rubin, Lewis J
Format:	Journal Article
Language:	English
Published:	England 01-02-2013
Subjects:	Administration, Inhalation Adolescent Adult Aged Antihypertensive Agents - administration & dosage Antihypertensive Agents - adverse effects Antihypertensive Agents - pharmacokinetics Arterial Pressure - drug effects Drug Administration Schedule Drug Substitution Epoprostenol - administration & dosage Epoprostenol - adverse effects Epoprostenol - analogs & derivatives Epoprostenol - pharmacokinetics Familial Primary Pulmonary Hypertension Female Humans Hypertension, Pulmonary - diagnosis Hypertension, Pulmonary - drug therapy Hypertension, Pulmonary - physiopathology Iloprost - administration & dosage Iloprost - adverse effects Iloprost - pharmacokinetics Male Middle Aged Prospective Studies Pulmonary Artery - drug effects Pulmonary Artery - physiopathology Quality of Life Time Factors Treatment Outcome United States Vasodilation - drug effects Vasodilator Agents - administration & dosage Vasodilator Agents - adverse effects Vasodilator Agents - pharmacokinetics Young Adult
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Summary:	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. 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. 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). Pulmonary arterial hypertension patients can be safely transitioned from inhaled iloprost to inhaled treprostinil while maintaining clinical status.
ISSN:	1755-5922
DOI:	10.1111/1755-5922.12008