title: Long-term experience after transition from parenteral prostanoids to oral agents in patients with pulmonary hypertension.
abstract: BACKGROUND
  Long-term follow-up after transition to oral agents from parenteral prostanoid therapy has not been well characterized.
  
  
  METHODS
  We reviewed our long-term experience after oral transitioning in patients with pulmonary hypertension. Patients were weaned off parenteral therapy based on a pre-determined outpatient protocol. Data were collected retrospectively after transition had taken place.
  
  
  RESULTS
  Twenty-one transitioned patients were identified. Fifteen patients (71.4%) were successfully transitioned (ST): 7 to bosentan, 5 to bosentan and sildenafil, and 3 to sildenafil. Six patients failed transition (FT). None of the patients in the FT group received sildenafil. Prior to transition attempt, patients in the ST group were treated with parenteral agents for a mean of 26 months vs. 16 months in the FT group (p=0.12). Maximal epoprostenol dose was low in both groups (ST 17.8 ng/kg/min vs. FT 14.5 ng/kg/min). Mean duration of oral therapy prior to transition was 11 months. After a mean follow-up of 24 months, most patients on both groups were able to maintain stable 6 min walk distance and hemodynamics. FT was not associated with short- or long-term adverse events.
  
  
  CONCLUSIONS
  Oral transition from parenteral prostanoid agents can be safely done in a selected group of patients. Most patients are able to maintain stable functional class and hemodynamics at long follow up regardless of success of transition attempt. Combination therapy with sildenafil appears to be associated with higher likelihood of successful transitioning.
authors.affiliation: Department of Pulmonary, Allergy, and Critical Care Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44124, USA.
authors.forename: Enrique
authors.initials: E
authors.lastname: Diaz-Guzman
authors.forename: Gustavo A
authors.initials: GA
authors.lastname: Heresi
authors.forename: Raed A
authors.initials: RA
authors.lastname: Dweik
authors.forename: Omar A
authors.initials: OA
authors.lastname: Minai
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D000077300:Bosentan; D016009:Chi-Square Distribution; D011464:Epoprostenol / Q000008:administration & dosage* / Q000031:analogs & derivatives / Q000627:therapeutic use; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy*; D007263:Infusions, Parenteral; D008297:Male; D008875:Middle Aged; D010879:Piperazines / Q000008:administration & dosage / Q000627:therapeutic use; D011453:Prostaglandins / Q000008:administration & dosage* / Q000627:therapeutic use; D011687:Purines / Q000008:administration & dosage / Q000627:therapeutic use; D012189:Retrospective Studies; D000068677:Sildenafil Citrate; D018709:Statistics, Nonparametric; D013449:Sulfonamides / Q000008:administration & dosage / Q000627:therapeutic use; D013450:Sulfones / Q000008:administration & dosage / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents; D010879:Piperazines; D011453:Prostaglandins; D011687:Purines; D013449:Sulfonamides; D013450:Sulfones; D000068677:Sildenafil Citrate; D011464:Epoprostenol; D000077300:Bosentan; C427248:treprostinil