title: Transitioning from parenteral to inhaled prostacyclin therapy in pulmonary arterial hypertension.
abstract: Parenteral prostacyclin therapy for PAH has allowed for improvements in functional status, quality of life and mortality. Parenteral therapies however carry an increased risk of line-associated complications. Inhaled prostacyclins are an attractive alternative therapy; however, limited data exists supporting the safety and outcomes after transition.
  
  
  
  We describe a retrospective observational analysis of adults with PAH who were transitioned from a parenteral prostacyclin to inhaled treprostinil at our institution. Endpoints include duration of transition, hospital length of stay, adverse effects during transition, and cardiopulmonary function post transition.
  
  
  
  Eight patients were included, all of which were on triple therapy. Seven patients receiving intravenous prostacyclin therapy were transitioned in an ICU setting, while one patient was transitioned from subcutaneous treprostinil as an outpatient. The average ICU and hospital length of stay was 4.1 ± 0.7 days. Patient preference was the most common reason for transition (n = 5), followed by line complication (n = 2), and intolerance to parenteral therapy (n = 1). One adverse event was observed while initiating inhaled treprostinil that only required slowing of the transition process. On follow-up (19.6 ± 11.1 months) functional class did not change, and non-parametric test showed no change in 6MWD after transition (p = 0.62). One patient failed inhaled therapy necessitating transition back to intravenous therapy.
  
  
  
  Transitioning patients from parenteral to inhaled prostacyclin therapy can be safely accomplished in specialized centers over a 48-72 h period. Patient preference was overwhelming the most prevalent reason for transition.
authors.affiliation: Pulmonary Vascular Disease Program, Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, FL, USA. Electronic address: aliataya@gmail.com.
authors.forename: Ali
authors.initials: A
authors.lastname: Ataya
authors.affiliation: Department of Internal Medicine, University of Florida, Gainesville, FL, USA.
authors.forename: Angelina
authors.initials: A
authors.lastname: Somoracki
authors.affiliation: Department of Pharmacy, University of Florida, Gainesville, FL, USA.
authors.forename: Jessica
authors.initials: J
authors.lastname: Cope
authors.affiliation: Pulmonary Vascular Disease Program, Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, FL, USA.
authors.forename: Hassan
authors.initials: H
authors.lastname: Alnuaimat
mesh_terms: D000280:Administration, Inhalation; D061605:Administration, Intravenous; D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D011464:Epoprostenol / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy* / Q000503:physiopathology; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D057240:Patient Preference; D011788:Quality of Life; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D000959:Antihypertensive Agents; D011464:Epoprostenol; C427248:treprostinil
keywords: Inhaled; Parenteral; Prostacyclin; Pulmonary arterial hypertension; Pulmonary hypertension; Transition