Successful withdrawal of long-term epoprostenol therapy for pulmonary arterial hypertension.
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.
Kim
Nick H
NH
Pulmonary Vascular Center, University of California, San Diego, CA, La Jolla 92037, USA.
Channick
Richard N
RN
Rubin
Lewis J
LJ
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
D000959:Antihypertensive Agents; D011464:Epoprostenol