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Inpatient Initiation of Oral Treprostinil in an Academic Medical System

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Abstract

Purpose

Clinicians may transition patients on parenteral or inhaled prostacyclins to oral treprostinil for ease of use or to avoid adverse effects related to parenteral therapy. However, few data are available to guide these transitions in inpatients. The purpose of this analysis is to describe the inpatient initiation of oral treprostinil at an academic medical system.

Methods

This is a retrospective cohort analysis of patients newly initiated on oral treprostinil at Cleveland Clinic Heath System from 2015 to 2017. Demographic information regarding pulmonary arterial hypertension (PAH) history and previous PAH therapies were recorded. Outcomes evaluated included doses of oral treprostinil utilized, adverse effects related to therapy, and measures of clinical and functional status before and after the initiation of oral treprostinil.

Results

Overall, 29 patients were prescribed oral treprostinil, of which 15 patients were included in the analysis. Common reasons for initiation of oral treprostinil included disease progression (6, 40%) and patient desire (4, 25%). The median duration of transition/initiation of oral treprostinil was 4 days (range, 3–11 days). Median daily dose of oral treprostinil on day 1 of initiation was 2 mg (0.25–4 mg). By day 7, median daily dose was 15 mg (0.75–27.75 mg). Common adverse effects related to therapy were gastrointestinal (7, 47%) and headache (4, 27%). No patients required discontinuation of oral treprostinil due to adverse effects within 90 days of initiation.

Conclusion

Inpatient initiation/transition to oral treprostinil was relatively well tolerated. Future studies should evaluate clinical outcomes surrounding the transitioning to oral treprostinil.

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Authors and Affiliations

  1. Department of Pharmacy, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44095, USA

    Benjamin Hohlfelder & Seth R. Bauer

  2. Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA

    Adriano R. Tonelli, Gustavo A. Heresi & Nancy Bair

  3. Department of Pulmonary and Critical Care Medicine, Cleveland Clinic Floirda, Weston, FL, USA

    Franck F. Rahaghi

Authors
  1. Benjamin Hohlfelder
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  2. Adriano R. Tonelli
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  3. Gustavo A. Heresi
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  4. Nancy Bair
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  5. Franck F. Rahaghi
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  6. Seth R. Bauer
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Corresponding author

Correspondence to Benjamin Hohlfelder.

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Conflict of Interest

Dr. Rahaghi reports receiving honoraria for speaking and consulting fees from United Therapeutics. All other authors report no conflicts of interest with any companies or organization whose products or services may be discussed in this article.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Due to the retrospective nature of the analysis, the Institutional Review Board did not require informed consent to be obtained from patients.

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Hohlfelder, B., Tonelli, A.R., Heresi, G.A. et al. Inpatient Initiation of Oral Treprostinil in an Academic Medical System. Cardiovasc Drugs Ther 34, 547–553 (2020). https://doi.org/10.1007/s10557-020-06992-0

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  • DOI: https://doi.org/10.1007/s10557-020-06992-0

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