title: Successful withdrawal of long-term epoprostenol therapy for pulmonary arterial hypertension.
abstract: BACKGROUND
  IV epoprostenol treatment of pulmonary arterial hypertension (PAH) has been believed to require an indefinite duration of therapy
  
  
  OBJECTIVE
  To describe the successful discontinuation of long-term epoprostenol therapy in four patients
  
  
  METHODS
  Case reports
  
  
  METHODS
  Outpatient clinic, tertiary-care hospital
  
  
  METHODS
  Four patients with acutely nonvasoreactive, World Health Organization (WHO) functional class IV PAH received long-term epoprostenol therapy. All patients subsequently demonstrated normalization of pulmonary arterial pressures on epoprostenol treatment. These patients were selected for epoprostenol withdrawal
  
  
  METHODS
  Down-titration and discontinuation of epoprostenol
  
  
  RESULTS
  All four patients were safely transitioned from epoprostenol to oral therapies and have maintained WHO functional class I-II for a mean of 11 months (range, 8 to 16 months). The duration of epoprostenol therapy prior to discontinuation averaged 5.7 years (range, 2.4 to 13.5 years)
  
  
  CONCLUSIONS
  Epoprostenol may sufficiently reverse the pathogenic process in select patients with PAH to allow a transition to less complex and less invasive treatment modalities.
authors.affiliation: Pulmonary Vascular Center, University of California, San Diego, CA, La Jolla 92037, USA.
authors.forename: Nick H
authors.initials: NH
authors.lastname: Kim
authors.forename: Richard N
authors.initials: RN
authors.lastname: Channick
authors.forename: Lewis J
authors.initials: LJ
authors.lastname: Rubin
mesh_terms: D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000008:administration & dosage*; D011464:Epoprostenol / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy*; D008875:Middle Aged; D012074:Remission Induction; D013997:Time Factors
chemical_list: D000959:Antihypertensive Agents; D011464:Epoprostenol