Chest
Clinical InvestigationsPulmonary HypertensionTransitioning From IV Epoprostenol to Subcutaneous Treprostinil in Pulmonary Arterial Hypertension
Section snippets
Materials and Methods
Eight patients with severe PAH who had initial clinical improvement (improved symptoms, exercise capacity) with long-term IV epoprostenol administration, but presented with life-threatening complications of this treatment, gave written informed consent to the study. All patients were followed up at centers experienced in long-term IV epoprostenol therapy, and which had participated in a randomized controlled trial11 of long-term subcutaneous treprostinil therapy in New York Heart Association
Results
The baseline characteristics of the patients are summarized in Table 1. Five of the patients had primary pulmonary hypertension, which was associated with fenfluramine ingestion in three patients and associated with HIV infection in one patient. One patient had pulmonary hypertension associated with portal hypertension, one patient had a congenital left-to-right cardiac shunt, and one patient had scleroderma. All patients had been severely ill, NYHA class III or IV, before the institution of IV
Discussion
The present results demonstrate that the transition from IV epoprostenol to subcutaneous treprostinil is safe, with excellent intermediate (4 to 11 months) results, in patients with severe PAH in whom epoprostenol therapy is effective but complicated by life-threatening side effects.
Severe PAH is a rapidly progressive and fatal disease that remains incurable.13 However, patient outcome has been improved in recent years by several therapeutic advances.13 The most significant advance has
ACKNOWLEDGMENT
The authors thank Allison Widlitz, PA-C, Evelyn Horn, MD, and Amy Yoney, RN, Columbia Presbyterian Medical Center, New York, NY; Jeanne Houtchens, RN, RI Hospital, Providence, RI; Don Lobacz, RN, St. Luke's Medical Center, Milwaukee, WI; Marie-Therese Gautier, RN, Erasme University Hospital, Brussels, Belgium; and James Crow, PhD, Robin Flinchbaugh, BS, and Kim Kusy, BS, United Therapeutics Corporation, Research Triangle Park, NC.
References (16)
- et al.
Primary pulmonary hypertension: improved long-term effects and survival with continuous intravenous epoprostenol infusion
J Am Coll Cardiol
(1997) - et al.
The effects of 15AU81, a chemically stable prostacyclin analogue, on the cardiovascular and renin-angiotensin systems of anesthetized dogs
Prostaglandins Leukot Essent Fatty Acids
(1991) - et al.
The pharmacokinetics and pharmacodynamics of prostacyclin analogue 15AU81 in anesthetized beagle dog
Prostaglandins Leukot Essent Fatty Acids
(1993) - et al.
Prostacyclin (epoprostenol) and heart-lung transplantation as treatments for severe pulmonary hypertension
Br Heart J
(1993) - et al.
Treatment of primary pulmonary hypertension with continuous intravenous prostacyclin (epoprostenol): results of a randomized trial
Ann Intern Med
(1990) - et al.
Survival in primary pulmonary hypertension with long-term continuous intravenous prostacyclin
Ann Intern Med
(1994) - et al.
A comparison of continuous intravenous epoprostenol (prostacyclin) with conventional therapy for primary pulmonary hypertension
N Engl J Med
(1996) - et al.
Reduction in pulmonary vascular resistance with long-term epoprostenol (prostacyclin) therapy in primary pulmonary hypertension
N Engl J Med
(1998)
Cited by (0)
This study was supported by United Therapeutics Corporation, Research Triangle Park, NC.
Drs. Vachiéry, Hill, Zwicke, Barst, and Naeije were principal investigators and/or members of the steering committee of a randomized controlled trial of the efficacy and safety of treprostinil in pulmonary arterial hypertension and, as such, received indirect support from United Therapeutics Corporation. Dr. Blackburn is an employee of United Therapeutics Corporation.