Chest
Volume 121, Issue 5, May 2002, Pages 1561-1565
Journal home page for Chest

Clinical Investigations
Pulmonary Hypertension
Transitioning From IV Epoprostenol to Subcutaneous Treprostinil in Pulmonary Arterial Hypertension

https://doi.org/10.1378/chest.121.5.1561Get rights and content

Objective

Continuous IV epoprostenol (prostacyclin) therapy improves survival and quality of life in patients with pulmonary arterial hypertension (PAH). IV epoprostenol therapy may be limited by serious complications related to the need for an implanted central venous catheter, and its chemical instability and short half-life. Treprostinil is a longer-acting prostacyclin analog, chemically stable, and suitable for continuous subcutaneous administration. We report successful transitioning to subcutaneous treprostinil of patients who presented with life-threatening complications of IV epoprostenol delivery.

Design

Open, uncontrolled study.

Setting

ICUs and departments of cardiology at academic hospitals.

Patients

Eight patients with PAH treated with continuous IV epoprostenol.

Intervention

Transition to subcutaneous treprostinil following an empiric protocol.

Results

Transition to treprostinil was achieved successfully in 21 to 96 h, with no major adverse side effects, and no change in the improved clinical status achieved with IV epoprostenol. Doses of epoprostenol before transition ranged from 3.5 to 75 ng/kg/min (mean, 27 ng/kg/min). Doses of treprostinil at completion of the transition ranged from 3 to 65 ng/kg/min (mean, 22 ng/kg/min). Four to 11 months later, the patients remained clinically improved. In spite of mild-to-moderate infusion site pain, all patients reported an improved sense of comfort and well-being.

Conclusion

Patients with PAH can be safely transitioned from treatment with IV epoprostenol to subcutaneous treprostinil.

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)

There are more references available in the full text version of this article.

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.

View full text