TY - JOUR
T1 - Right ventricular afterload predicts long-term transition from parenteral to oral treprostinil in pulmonary arterial hypertension
AU - Maestas, Travis
AU - Hansen, Lillian M.
AU - Vanderpool, Rebecca R.
AU - Desai, Ankit A.
AU - Airhart, Sophia
AU - Knapp, Shannon M.
AU - Cohen, Adam
AU - Feldman, Jeremy
AU - Rischard, Franz P.
N1 - Funding Information:
FPR has received grant funding and consultancy and advisory board compensation from Gilead, Actelion Pharmaceuticals, Bayer and United Therapeutics. JF serves as consultant to United Therapeutics, Gilead, Actelion, Bayer and Reata. He serves as speaker for Gilead, Bayer, and United Therapeutics.
Funding Information:
FPR is funded by the National Heart Lung and Blood Institute (NHLBI U01 grant RFA-HL-14-027). AAD is funded by the NHLBI R01 HL 136603. SA has received advisory board compensation from Bayer.
Publisher Copyright:
© The Author(s) 2018.
PY - 2018/10/1
Y1 - 2018/10/1
N2 - Despite the increasing trends, reports on long-term follow-up are limited on transitioning from parenteral to oral treprostinil therapy in patients with pulmonary arterial hypertension (PAH). We investigated both the effectiveness of parenteral to oral treprostinil transition and the characteristics associated with transition failure over a duration of two years. The study included 37 Group I functional class I and II patients with PAH on combination therapy. Patients were excluded if cardiac index ≤2.2 L/min/m2, right atrial pressure ≥11 mmHg, or 6-min walk distance ≤250 m. Patients were categorized as successful (STransition) or unsuccessful (UTransition) transition based on clinical stability, or a parenteral comparator (CParenteral) if they remained on parenteral therapy (no transition). All patients underwent two right heart catheterizations, one at enrollment and a second post transition. Of 24 total transition patients, 46% were classified as UTransition. UTransition occurred on average 577 days post transition. Both UTransition and STransition had similar hemodynamics at diagnosis and treprostinil dose before and after transition. Before transition, the pulmonary vascular resistance (PVR) was significantly higher in the UTransition (6.7 ± 2 WU) vs. STransition group (3.5 ± 1.5 WU). At follow-up catheterization, the UTransition group demonstrated further increases in PVR, greater than the CParenteral group, without recovery despite “rescue” therapy in the UTransition group. A pre-transition PVR of 4.16 WU discriminated the UTransition from the STransition group. While a subset of PAH patients on combination therapy may be safely transitioned from parenteral to oral treprostinil, caution should be exercised in patients with elevated baseline PVR to avoid irreversible destabilization.
AB - Despite the increasing trends, reports on long-term follow-up are limited on transitioning from parenteral to oral treprostinil therapy in patients with pulmonary arterial hypertension (PAH). We investigated both the effectiveness of parenteral to oral treprostinil transition and the characteristics associated with transition failure over a duration of two years. The study included 37 Group I functional class I and II patients with PAH on combination therapy. Patients were excluded if cardiac index ≤2.2 L/min/m2, right atrial pressure ≥11 mmHg, or 6-min walk distance ≤250 m. Patients were categorized as successful (STransition) or unsuccessful (UTransition) transition based on clinical stability, or a parenteral comparator (CParenteral) if they remained on parenteral therapy (no transition). All patients underwent two right heart catheterizations, one at enrollment and a second post transition. Of 24 total transition patients, 46% were classified as UTransition. UTransition occurred on average 577 days post transition. Both UTransition and STransition had similar hemodynamics at diagnosis and treprostinil dose before and after transition. Before transition, the pulmonary vascular resistance (PVR) was significantly higher in the UTransition (6.7 ± 2 WU) vs. STransition group (3.5 ± 1.5 WU). At follow-up catheterization, the UTransition group demonstrated further increases in PVR, greater than the CParenteral group, without recovery despite “rescue” therapy in the UTransition group. A pre-transition PVR of 4.16 WU discriminated the UTransition from the STransition group. While a subset of PAH patients on combination therapy may be safely transitioned from parenteral to oral treprostinil, caution should be exercised in patients with elevated baseline PVR to avoid irreversible destabilization.
KW - drug delivery
KW - pulmonary arterial hypertension
KW - right ventricle function and dysfunction
UR - http://www.scopus.com/inward/record.url?scp=85054807008&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85054807008&partnerID=8YFLogxK
U2 - 10.1177/2045894018797270
DO - 10.1177/2045894018797270
M3 - Article
AN - SCOPUS:85054807008
VL - 8
JO - Pulmonary Circulation
JF - Pulmonary Circulation
SN - 2045-8932
IS - 4
ER -