Skip to main content
SpringerLink
Log in

Ambulatory Transition from Parenteral Prostanoid to Inhaled Treprostinil in Patients with Pulmonary Arterial Hypertension

  • PULMONARY HYPERTENSION
  • Published:
Lung Aims and scope Submit manuscript

Abstract

Purpose

The intravenous or subcutaneous delivery of prostanoid drugs for moderate to severe pulmonary arterial hypertension has been fraught with complications and patient dissatisfaction. Combination therapy including inhaled treprostinil is an attractive alternative in clinically stable patients. Uncertainties exist about the patient characteristics and the optimal setting (inpatient versus office/home) for transition.

Methods

Sixteen stable patients with pulmonary arterial hypertension and favorable risk profile were transitioned from parenteral prostanoid to combination therapy including inhaled treprostinil in the home setting. Nine patients were using intravenous treprostinil, two patients were using subcutaneous treprostinil, and five patients were using intravenous epoprostenol at a median dose of 80 (interquartile range, IQR 72–90), 76.5 (68 and 85), and 28 (IQR 26–30) ng/kg/min respectively. Patients were followed up for a median of 732.5 days after transition (IQR 506.5–1294 days).

Results

Patients tolerated the transition to inhaled treprostinil well without significant change in functional class (81.25% FC I/II before transition vs. 87.5% after), 6-min walk distance [349 m (IQR 226–461 m) to 364 m (IQR 238–565 m), p = 0.09] or NT-proBNP [149 pg/ml (IQR 71.5–383 pg/ml) to 186.5 pg/ml (IQR 83.5–444 pg/ml), p = 0.38]. Hemodynamic data, where available, showed significant improvements in mean pulmonary artery pressure and pulmonary vascular resistance from 36 mmHg (IQR 27–46.5 mmHg) and 5.2 Wood Units (WU) (IQR 3.1–5.6 WU) to 28.5 mmHg (IQR 22–35.5 mmHg) and 3.2 WU (IQR 2.4–4.2 WU) (p-values 0.022 and 0.003). More patients were on triple therapy after transition, and side effects reported were less severe.

Conclusion

For select patients, transition from a parenteral prostanoid-based therapy to a combination regimen including inhaled treprostinil in the home setting appears safe and well tolerated.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Galie N, Humbert M, Vachiery JL, Gibbs S, Lang I, Torbicki A, Simonneau G, Peacock A, Vonk Noordegraaf A, Beghetti M et al (2016) 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT). Eur Heart J 37(1):67–119

    Article  Google Scholar 

  2. Taichman DB, Ornelas J, Chung L, Klinger JR, Lewis S, Mandel J, Palevsky HI, Rich S, Sood N, Rosenzweig EB et al (2014) Pharmacologic therapy for pulmonary arterial hypertension in adults: CHEST guideline and expert panel report. Chest 146(2):449–475

    Article  Google Scholar 

  3. LeVarge BL (2015) Prostanoid therapies in the management of pulmonary arterial hypertension. Ther Clin Risk Manag 11:535–547

    Article  CAS  Google Scholar 

  4. Sitbon O, Humbert M, Nunes H, Parent F, Garcia G, Hervé P, Rainisio M, Simonneau G (2002) Long-term intravenous epoprostenol infusion in primary pulmonary hypertension. J Am Coll Cardiol 40(4):780–788

    Article  CAS  Google Scholar 

  5. Kallen AJ, Lederman E, Balaji A, Trevino I, Petersen EE, Shoulson R, Saiman L, Horn EM, Gomberg-Maitland M, Barst RJ et al (2008) Bloodstream infections in patients given treatment with intravenous prostanoids. Infect Control Hosp Epidemiol 29(4):342–349

    Article  Google Scholar 

  6. Roman A, Barbera JA, Escribano P, Sala ML, Febrer L, Oyaguez I, Sabater E, Casado MA (2012) Cost effectiveness of prostacyclins in pulmonary arterial hypertension. Appl Health Econ Health Policy 10(3):175–188

    Article  Google Scholar 

  7. Hall H, Cote J, McBean A, Purden M (2012) The experiences of patients with pulmonary arterial hypertension receiving continuous intravenous infusion of epoprostenol (Flolan) and their support persons. Heart Lung 41(1):35–43

    Article  Google Scholar 

  8. Galiè N, Channick RN, Frantz RP et al (2019) Risk stratification and medical therapy of pulmonary arterial hypertension. Eur Respir J 53:1801889

    Article  Google Scholar 

  9. Ataya A, Somoracki A, Cope J, Alnuaimat H (2016) Transitioning from parenteral to inhaled prostacyclin therapy in pulmonary arterial hypertension. Pulm Pharmacol Ther 40:39–43

    Article  CAS  Google Scholar 

  10. de Jesus Perez VA, Rosenzweig E, Rubin LJ, Poch D, Bajwa A, Park M, Jain M, Bourge RC, Kudelko K, Spiekerkoetter E et al (2012) Safety and efficacy of transition from systemic prostanoids to inhaled treprostinil in pulmonary arterial hypertension. Am J Cardiol 110(10):1546–1550

    Article  Google Scholar 

  11. Enderby CY, Soukup M, Al Omari M, Zeiger T, Burger C (2014) Transition from intravenous or subcutaneous prostacyclin therapy to inhaled treprostinil in patients with pulmonary arterial hypertension: a retrospective case series. J Clin Pharm Ther 39(5):496–500

    Article  CAS  Google Scholar 

  12. Raina A, Coons JC, Kanwar M, Murali S, Sokos G, Benza RL (2013) Transitioning from parenteral treprostinil to inhaled treprostinil in patients with pulmonary arterial hypertension. Pulm Circ 3(1):116–120

    Article  CAS  Google Scholar 

  13. Oudiz R, Agarwal M, Rischard F, De Marco T (2016) An advanced protocol-driven transition from parenteral prostanoids to inhaled trepostinil in pulmonary arterial hypertension. Pulm Circ 6(4):532–538

    Article  Google Scholar 

  14. Chakinala MM, Feldman JP, Rischard F, Mathier M, Broderick M, Leedom N, Laliberte K, White RJ (2017) Transition from parenteral to oral treprostinil in pulmonary arterial hypertension. J Heart Lung Transplant 36(2):193–201

    Article  Google Scholar 

  15. Parikh KS, Rajagopal S, Fortin T, Tapson VF, Poms AD (2016) Safety and tolerability of high-dose inhaled treprostinil in pulmonary hypertension. J Cardiovasc Pharmacol 67(4):322–325

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Section of Pulmonary and Critical Care Medicine, The University of Chicago Medicine, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA

    Lucas M. Kimmig & Remzi Bag

  2. Department of Public Health Sciences, The University of Chicago, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA

    Chuanhong Liao

  3. Biological Sciences Division, The University of Chicago, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA

    Remzi Bag

Authors
  1. Lucas M. Kimmig
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Chuanhong Liao
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Remzi Bag
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Remzi Bag.

Ethics declarations

Conflict of interest

Lucas Kimmig has no relevant conflicts of interest to disclose. Lucas Kimmig received support from the NIH T32 Training Grant in Respiratory Biology (5T32HL007605). Chuanhong Liao has no relevant conflict of interest to disclose. Remzi Bag has served as consultant/speaker for Actelion Pharmaceuticals, Cipla, Gilead Sciences, and Bayer; and has received research grants from Gilead Sciences, Reata Pharma, Actelion, Medtronics, Liquidia Technologies, PhaseBio, Arena Pharma, Lung Biotechnology and United Therapeutics Corp. This work was supported by a grant from United Therapeutics Corporation. The funding source was not involved in the data collection, analysis, or interpretation, and did not have the right to approve or disapprove publication.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

408_2019_306_MOESM1_ESM.png

Electronic supplementary material 1—Hemodynamic data for 8 patients when re-measured manually using catheterization data and waveforms (PNG 72 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kimmig, L.M., Liao, C. & Bag, R. Ambulatory Transition from Parenteral Prostanoid to Inhaled Treprostinil in Patients with Pulmonary Arterial Hypertension. Lung 198, 53–58 (2020). https://doi.org/10.1007/s00408-019-00306-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00408-019-00306-4

Keywords

Search

Navigation