Chest
Clinical InvestigationsPULMONARY VASCULAR DISEASETransition From Epoprostenol and Treprostinil to the Oral Endothelin Receptor Antagonist Bosentan in Patients With Pulmonary Hypertension
Section snippets
Patient Selection
Patients with PAH receiving prostacyclin who wanted to transition from parenteral prostacyclin were assessed for the potential transition to oral bosentan. Patients selected as appropriate for this transition had to demonstrate stability, defined as the need for infrequent (once or less per month) increases in prostaglandin dose, WHO functional class II or III, and with no clinical evidence of heart failure (ie, jugular venous distension, pulsatile liver, lower-extremity edema, etc.). Patients
Results
Twenty-three stable patients with PAH in WHO class II and III receiving continuous prostacyclin infusion attempted transition to oral bosentan. Patient demographics are shown in Table 1. The patients were predominantly female (19 of 23 patients), and PPH was the predominant diagnosis. Seventeen patients were receiving epoprostenol (10 to 76 ng/kg/min; mean dose, 36 ng/kg/min), and 6 patients were receiving treprostinil (28 to 150 ng/kg/min; mean dose, 79 ng/kg/min).
Of the original 23 patients,
Discussion
There is a single, recent article13 that reports successful cessation of epoprostenol in three patients who experienced normalization of their PAPs following years of prostacyclin therapy. This article, from one of the largest pulmonary hypertension centers in the United States, demonstrates the rarity of this occurrence. In contrast, the risk of sudden death with prostacyclin interruption is well recognized. There have been no published studies to date demonstrating safe and effective
Conclusion
A significant number of patients with PAH receiving continuous prostacyclin therapy can be effectively and safely transitioned to oral bosentan, thereby reducing the burden of adverse effects experienced by patients due to prostacyclin therapy and the delivery systems. This transition can be successfully and safely achieved using noninvasive monitoring. Patients who were transitioned in this study were carefully selected and had stable disease. Based on this small study, there does not appear
ACKNOWLEDGMENT
We thank Jan Schneider, RN, and Helena Purl, RN, for their assistance in compiling the data for this study.
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Cited by (0)
This work was supported by a research grant from the Frueauff Foundation.
This work was presented in poster form at the American Thoracic Society International Conference 2003, May 16–21, 2003, Seattle, WA, and the presenter was supported by a travel grant from Actelion.