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Transition from intravenous epoprostenol to intravenous treprostinil in pulmonary hypertension.
Am J Respir Crit Care Med. 2005 Dec 15; 172(12):1586-9.AJ

Abstract

RATIONALE

Intravenous epoprostenol improves exercise capacity and survival in patients with pulmonary arterial hypertension. The prostacyclin analog treprostinil is also efficacious by subcutaneous infusion, is easier to administer, and has a longer half-life. With the demonstration of bioequivalence between subcutaneous and intravenous treprostinil, intravenous treprostinil may have an overall better risk-benefit profile than intravenous epoprostenol.

OBJECTIVE

To evaluate the safety and efficacy of transitioning patients with pulmonary arterial hypertension from intravenous epoprostenol to intravenous treprostinil.

METHODS

Patients enrolled in a 12-wk prospective open label study were switched from intravenous epoprostenol to intravenous treprostinil over 24 to 48 h. The intravenous treprostinil dose was adjusted to minimize symptoms/side effects.

RESULTS

Thirty-one patients (mean age, 43 yr; 22 women) were enrolled. Twenty-seven patients completed the protocol; 4 patients transitioned back to epoprostenol. Six-minute walk distance (n = 27; baseline, 438 +/- 16 m; Week 12, 439 +/- 16 m), Naughton-Balke treadmill test time (n = 26; baseline, 582 +/- 50 s; Week 12, 622 +/- 48 s), functional class, and Borg score were maintained with intravenous treprostinil at Week 12 versus intravenous epoprostenol before transition. At Week 12, mean pulmonary artery pressure increased 4 +/- 1 mm Hg (n = 27, p < 0.01), cardiac index decreased 0.4 +/- 0.1 L/min/m2 (n = 27, p = 0.01), and pulmonary vascular resistance increased 3 +/- 1 Wood units x m2 (n = 26, p < 0.01). No serious adverse events were attributed to treprostinil.

CONCLUSIONS

These data suggest that transition from intravenous epoprostenol to intravenous treprostinil is safe and effective; whether the hemodynamic differences associated with intravenous treprostinil are clinically important requires longer follow-up.

Authors+Show Affiliations

Pulmonary Hypertension Center, University of Chicago Hospitals, 5841 South Maryland Avenue, MC 2016, Chicago, IL 60637, USA. mgomberg@medicine.bsd.uchicago.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

16151039

Citation

Gomberg-Maitland, Mardi, et al. "Transition From Intravenous Epoprostenol to Intravenous Treprostinil in Pulmonary Hypertension." American Journal of Respiratory and Critical Care Medicine, vol. 172, no. 12, 2005, pp. 1586-9.
Gomberg-Maitland M, Tapson VF, Benza RL, et al. Transition from intravenous epoprostenol to intravenous treprostinil in pulmonary hypertension. Am J Respir Crit Care Med. 2005;172(12):1586-9.
Gomberg-Maitland, M., Tapson, V. F., Benza, R. L., McLaughlin, V. V., Krichman, A., Widlitz, A. C., & Barst, R. J. (2005). Transition from intravenous epoprostenol to intravenous treprostinil in pulmonary hypertension. American Journal of Respiratory and Critical Care Medicine, 172(12), 1586-9.
Gomberg-Maitland M, et al. Transition From Intravenous Epoprostenol to Intravenous Treprostinil in Pulmonary Hypertension. Am J Respir Crit Care Med. 2005 Dec 15;172(12):1586-9. PubMed PMID: 16151039.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Transition from intravenous epoprostenol to intravenous treprostinil in pulmonary hypertension. AU - Gomberg-Maitland,Mardi, AU - Tapson,Victor F, AU - Benza,Raymond L, AU - McLaughlin,Vallerie V, AU - Krichman,Abigail, AU - Widlitz,Allison C, AU - Barst,Robyn J, Y1 - 2005/09/08/ PY - 2005/9/10/pubmed PY - 2006/2/24/medline PY - 2005/9/10/entrez SP - 1586 EP - 9 JF - American journal of respiratory and critical care medicine JO - Am. J. Respir. Crit. Care Med. VL - 172 IS - 12 N2 - RATIONALE: Intravenous epoprostenol improves exercise capacity and survival in patients with pulmonary arterial hypertension. The prostacyclin analog treprostinil is also efficacious by subcutaneous infusion, is easier to administer, and has a longer half-life. With the demonstration of bioequivalence between subcutaneous and intravenous treprostinil, intravenous treprostinil may have an overall better risk-benefit profile than intravenous epoprostenol. OBJECTIVE: To evaluate the safety and efficacy of transitioning patients with pulmonary arterial hypertension from intravenous epoprostenol to intravenous treprostinil. METHODS: Patients enrolled in a 12-wk prospective open label study were switched from intravenous epoprostenol to intravenous treprostinil over 24 to 48 h. The intravenous treprostinil dose was adjusted to minimize symptoms/side effects. RESULTS: Thirty-one patients (mean age, 43 yr; 22 women) were enrolled. Twenty-seven patients completed the protocol; 4 patients transitioned back to epoprostenol. Six-minute walk distance (n = 27; baseline, 438 +/- 16 m; Week 12, 439 +/- 16 m), Naughton-Balke treadmill test time (n = 26; baseline, 582 +/- 50 s; Week 12, 622 +/- 48 s), functional class, and Borg score were maintained with intravenous treprostinil at Week 12 versus intravenous epoprostenol before transition. At Week 12, mean pulmonary artery pressure increased 4 +/- 1 mm Hg (n = 27, p < 0.01), cardiac index decreased 0.4 +/- 0.1 L/min/m2 (n = 27, p = 0.01), and pulmonary vascular resistance increased 3 +/- 1 Wood units x m2 (n = 26, p < 0.01). No serious adverse events were attributed to treprostinil. CONCLUSIONS: These data suggest that transition from intravenous epoprostenol to intravenous treprostinil is safe and effective; whether the hemodynamic differences associated with intravenous treprostinil are clinically important requires longer follow-up. SN - 1073-449X UR - https://www.unboundmedicine.com/medline/citation/16151039/Transition_from_intravenous_epoprostenol_to_intravenous_treprostinil_in_pulmonary_hypertension_ L2 - http://www.atsjournals.org/doi/full/10.1164/rccm.200505-766OC?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -