title: Continuous subcutaneous infusion of treprostinil, a prostacyclin analogue, in patients with pulmonary arterial hypertension: a double-blind, randomized, placebo-controlled trial.
abstract: Pulmonary arterial hypertension is a life-threatening disease for which continuous intravenous prostacyclin has proven to be effective. However, this treatment requires a permanent central venous catheter with the associated risk of serious complications such as sepsis, thromboembolism, or syncope. Treprostinil, a stable prostacyclin analogue, can be administered by a continuous subcutaneous infusion, avoiding these risks. We conducted a 12-week, double-blind, placebo-controlled multicenter trial in 470 patients with pulmonary arterial hypertension, either primary or associated with connective tissue disease or congenital systemic-to-pulmonary shunts. Exercise capacity improved with treprostinil and was unchanged with placebo; the between treatment group difference in median six-minute walking distance was 16 m (p = 0.006). Improvement in exercise capacity was greater in the sicker patients and was dose-related, but independent of disease etiology. Concomitantly, treprostinil significantly improved indices of dyspnea, signs and symptoms of pulmonary hypertension, and hemodynamics. The most common side effect attributed to treprostinil was infusion site pain (85%) leading to premature discontinuation from the study in 8% of patients. Three patients in the treprostinil treatment group presented with an episode of gastrointestinal hemorrhage. We conclude that chronic subcutaneous infusion of treprostinil is an effective treatment with an acceptable safety profile in patients with pulmonary arterial hypertension.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Antoine Béclère Hospital, Clamart, Paris-Sud University, Clamart, France. gerald.simonneau@abc.ap-hop-paris.fr
authors.forename: Gerald
authors.initials: G
authors.lastname: Simonneau
authors.forename: Robyn J
authors.initials: RJ
authors.lastname: Barst
authors.forename: Nazzareno
authors.initials: N
authors.lastname: Galie
authors.forename: Robert
authors.initials: R
authors.lastname: Naeije
authors.forename: Stuart
authors.initials: S
authors.lastname: Rich
authors.forename: Robert C
authors.initials: RC
authors.lastname: Bourge
authors.forename: Anne
authors.initials: A
authors.lastname: Keogh
authors.forename: Ronald
authors.initials: R
authors.lastname: Oudiz
authors.forename: Adaani
authors.initials: A
authors.lastname: Frost
authors.forename: Shelmer D
authors.initials: SD
authors.lastname: Blackburn
authors.forename: James W
authors.initials: JW
authors.lastname: Crow
authors.forename: Lewis J
authors.initials: LJ
authors.lastname: Rubin
mesh_terms: D000328:Adult; D000959:Antihypertensive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D004311:Double-Blind Method; D011464:Epoprostenol / Q000009:adverse effects / Q000031:analogs & derivatives*; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy*; D007260:Infusion Pumps; D007279:Injections, Subcutaneous; D016014:Linear Models; D008297:Male; D018579:Patient Selection; D010807:Physical Endurance / Q000187:drug effects; D018709:Statistics, Nonparametric
chemical_list: D000959:Antihypertensive Agents; D011464:Epoprostenol