Transitioning from i.v. epoprostenol to subcutaneous treprostinil in pulmonary arterial hypertension.
OBJECTIVE
Continuous i.v. epoprostenol (prostacyclin) therapy improves survival and quality of life in patients with pulmonary arterial hypertension (PAH). i.v. 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 i.v. epoprostenol delivery.


METHODS
Open, uncontrolled study.


METHODS
ICUs and departments of cardiology at academic hospitals.


METHODS
Eight patients with PAH treated with continuous i.v. epoprostenol.


METHODS
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 i.v. 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.


CONCLUSIONS
Patients with PAH can be safely transitioned from treatment with i.v. epoprostenol to subcutaneous treprostinil.
Vachiéry
Jean-Luc
JL
Department of Cardiology, Erasme University Hospital, Brussels, Belgium.
Hill
Nicholas
N
Zwicke
Diane
D
Barst
Robyn
R
Blackburn
Shelmer
S
Naeije
Robert
R
D000328:Adult; D000959:Antihypertensive Agents / Q000008:administration & dosage*; D011464:Epoprostenol / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy* / Q000503:physiopathology; D007260:Infusion Pumps; D007262:Infusions, Intravenous; D007279:Injections, Subcutaneous; D008297:Male; D008875:Middle Aged
D000959:Antihypertensive Agents; D011464:Epoprostenol