PMID- 27469018
OWN - NLM
STAT- MEDLINE
DCOM- 20180228
LR  - 20180228
IS  - 1557-3117 (Electronic)
IS  - 1053-2498 (Linking)
VI  - 36
IP  - 2
DP  - 2017 Feb
TI  - Transition from parenteral to oral treprostinil in pulmonary arterial
      hypertension.
PG  - 193-201
LID - S1053-2498(16)30197-8 [pii]
LID - 10.1016/j.healun.2016.06.019 [doi]
AB  - BACKGROUND: Parenteral prostanoids are effective treatment for pulmonary arterial
      hypertension, but long-term pump infusion systems have significant
      delivery-related safety and convenience limitations. METHODS: Subjects with a
      favorable risk profile transitioned from parenteral to oral treprostinil using a 
      protocol-driven titration during 5 days of inpatient observation. Baseline and
      Week 24 assessments included 6-minute walk distance, echocardiogram, right heart 
      catheterization, pharmacokinetics, treatment satisfaction and quality of life.
      Thirty-three subjects (76% female, mean age 50 years) enrolled; 85% were using
      subcutaneous treprostinil with a median dose of 57 (range 25 to 111) ng/kg/min.
      Participants were using background, approved non-prostanoid therapy, including 9 
      on 2 oral therapies; baseline right atrial pressure and cardiac output were in
      the normal range. All 33 subjects transitioned to oral treprostinil therapy
      within 4 weeks, but 2 transitioned back to parenteral drug before Week 24. At
      Week 24, subjects were taking a median total daily dose of 44 (15 to 75) mg, with
      25 of 31 using a 3-times-daily regimen at 7- to 9-hour intervals. RESULTS: The
      6-minute walk distance was preserved (median +17 m [-98 to 95 m]) at its baseline
      of 446 m. Hemodynamic variables, including pulmonary vascular resistance, were
      similar at Week 24 except for mixed venous saturation, which dropped from a
      median of 71% to 68% (p < 0.001). Overall quality of life and treatment
      satisfaction measures did not change; however, mood-related symptom and treatment
      convenience subscores improved. Common adverse effects included headache, nausea,
      flushing and diarrhea. CONCLUSIONS: Lower risk patients managed on parenteral
      treprostinil may be candidates for transition to a more convenient, oral form of 
      the drug.
CI  - Copyright (c) 2016 The Authors. Published by Elsevier Inc. All rights reserved.
FAU - Chakinala, Murali M
AU  - Chakinala MM
AD  - Department of Medicine, Washington University, St. Louis, Missouri, USA.
FAU - Feldman, Jeremy P
AU  - Feldman JP
AD  - Arizona Pulmonary Specialists, Ltd, Phoenix, Arizona, USA.
FAU - Rischard, Franz
AU  - Rischard F
AD  - Department of Medicine, University of Arizona, Tuscon, Arizona, USA.
FAU - Mathier, Michael
AU  - Mathier M
AD  - Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
FAU - Broderick, Meredith
AU  - Broderick M
AD  - United Therapeutics Corporation, Research Triangle Park, North Carolina, USA.
FAU - Leedom, Nicole
AU  - Leedom N
AD  - United Therapeutics Corporation, Research Triangle Park, North Carolina, USA.
FAU - Laliberte, Kevin
AU  - Laliberte K
AD  - United Therapeutics Corporation, Research Triangle Park, North Carolina, USA.
FAU - White, R James
AU  - White RJ
AD  - Division of Pulmonary and Critical Care Medicine and the Mary M. Parkes Center,
      University of Rochester Medical Center, University of Rochester Medical Center,
      Rochester, New York, USA. Electronic address: jim_white@urmc.rochester.edu.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Multicenter Study
DEP - 20160624
PL  - United States
TA  - J Heart Lung Transplant
JT  - The Journal of heart and lung transplantation : the official publication of the
      International Society for Heart Transplantation
JID - 9102703
RN  - 0 (Prostaglandins)
RN  - DCR9Z582X0 (Epoprostenol)
RN  - RUM6K67ESG (treprostinil)
SB  - IM
MH  - Administration, Oral
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Cohort Studies
MH  - Dose-Response Relationship, Drug
MH  - Drug Administration Schedule
MH  - Epoprostenol/administration & dosage/adverse effects/*analogs & derivatives
MH  - Familial Primary Pulmonary Hypertension/diagnosis/drug therapy
MH  - Female
MH  - Humans
MH  - Hypertension, Pulmonary/diagnosis/*drug therapy
MH  - Infusions, Parenteral
MH  - Infusions, Subcutaneous
MH  - Male
MH  - Middle Aged
MH  - Patient Selection
MH  - Prostaglandins/*administration & dosage/adverse effects
MH  - *Quality of Life
MH  - Retrospective Studies
MH  - Risk Assessment
MH  - Severity of Illness Index
MH  - Time Factors
MH  - Treatment Outcome
MH  - Vascular Resistance/*drug effects
MH  - Young Adult
OTO - NOTNLM
OT  - hemodynamics
OT  - pharmacokinetics
OT  - pharmacology
OT  - prostaglandins
OT  - pulmonary hypertension
EDAT- 2016/07/30 06:00
MHDA- 2018/03/01 06:00
CRDT- 2016/07/30 06:00
PHST- 2016/03/22 00:00 [received]
PHST- 2016/05/12 00:00 [revised]
PHST- 2016/06/22 00:00 [accepted]
PHST- 2016/07/30 06:00 [pubmed]
PHST- 2018/03/01 06:00 [medline]
PHST- 2016/07/30 06:00 [entrez]
AID - S1053-2498(16)30197-8 [pii]
AID - 10.1016/j.healun.2016.06.019 [doi]
PST - ppublish
SO  - J Heart Lung Transplant. 2017 Feb;36(2):193-201. doi:
      10.1016/j.healun.2016.06.019. Epub 2016 Jun 24.