title: Rapid transition from inhaled iloprost to inhaled treprostinil in patients with pulmonary arterial hypertension.
abstract: BACKGROUND
  Inhaled treprostinil is a prostacyclin analog approved for the treatment of pulmonary arterial hypertension (PAH) that may provide a more convenient treatment option for patients receiving inhaled iloprost while maintaining the clinical benefit of inhaled prostacyclin therapy.
  
  
  OBJECTIVE
  In this open-label safety study, 73 PAH patients were enrolled with primarily World Health Organization Class II (56%) or III (42%) symptoms. At baseline, most patients (93%) were receiving 5 μg of iloprost per dose but 38% of patients reported a dosing frequency below the labeled rate of 6-9 times daily. Patients initiated inhaled treprostinil at 3 breaths four times daily (qid) at the immediate next scheduled iloprost dose. The primary objective was to assess the safety of rapid transition from iloprost to inhaled treprostinil; clinical status and quality of life were also assessed.
  
  
  RESULTS
  Most patients (84%) achieved the target treprostinil dose of 9 breaths qid and remained on study until transition to commercial therapy (89%). The most frequent adverse events (AEs) were cough (74%), headache (44%), and nausea (30%), and five patients prematurely discontinued study drug due to AE (n = 3), disease progression (n = 1), or death (n = 1). At week 12, the time spent on daily treatment activities was reduced compared to baseline, with a mean total savings of 1.4 h per day. Improvements were also observed at week 12 for 6-min walk distance (+16.0; P < 0.001), N-terminal pro-B-type natriuretic peptide (-74 pg/mL; P = 0.001), and the Cambridge Pulmonary Hypertension Outcome Review (all domains P < 0.001).
  
  
  CONCLUSIONS
  Pulmonary arterial hypertension patients can be safely transitioned from inhaled iloprost to inhaled treprostinil while maintaining clinical status.
authors.affiliation: University of Alabama at Birmingham, Birmingham, AL 35294, USA. bbourge@uab.edu
authors.forename: Robert C
authors.initials: RC
authors.lastname: Bourge
authors.forename: Victor F
authors.initials: VF
authors.lastname: Tapson
authors.forename: Zeenat
authors.initials: Z
authors.lastname: Safdar
authors.forename: Raymond L
authors.initials: RL
authors.lastname: Benza
authors.forename: Richard N
authors.initials: RN
authors.lastname: Channick
authors.forename: Erika B
authors.initials: EB
authors.lastname: Rosenzweig
authors.forename: Shelley
authors.initials: S
authors.lastname: Shapiro
authors.forename: R James
authors.initials: RJ
authors.lastname: White
authors.forename: Christopher Shane
authors.initials: CS
authors.lastname: McSwain
authors.forename: Stephen Karl
authors.initials: SK
authors.lastname: Gotzkowsky
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Nelsen
authors.forename: Lewis J
authors.initials: LJ
authors.lastname: Rubin
mesh_terms: D000280:Administration, Inhalation; D000293:Adolescent; D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics; D062186:Arterial Pressure / Q000187:drug effects*; D004334:Drug Administration Schedule; D057915:Drug Substitution; D011464:Epoprostenol / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000493:pharmacokinetics; D065627:Familial Primary Pulmonary Hypertension; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D016285:Iloprost / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011651:Pulmonary Artery / Q000187:drug effects* / Q000503:physiopathology; D011788:Quality of Life; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D014664:Vasodilation / Q000187:drug effects*; D014665:Vasodilator Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics; D055815:Young Adult
chemical_list: D000959:Antihypertensive Agents; D014665:Vasodilator Agents; D011464:Epoprostenol; D016285:Iloprost; C427248:treprostinil