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The role of treprostinil in the management of pulmonary hypertension.
Am J Cardiovasc Drugs. 2008; 8(4):213-7.AJ

Abstract

Pulmonary arterial hypertension (PAH) is a severely disabling disorder characterized by sustained elevations of pulmonary vascular resistance, ultimately leading to right-heart failure and death. Intravenous epoprostenol has been widely used in patients with PAH, leading to long-term clinical benefits and improved survival. Epoprostenol has to be delivered through a permanently implanted intravenous catheter, with the potential of life-threatening complications. Thus, treprostinil, a stable prostacyclin analog suitable for subcutaneous administration, has been developed. Treprostinil is chemically stable at room temperature, has a long half-life (2-4 hours), and has similar pharmacologic properties with comparable hemodynamic effects as epoprostenol.A large, double-blind, placebo-controlled, multicenter, 12-week study confirmed the efficacy of subcutaneous treprostinil, by improving exercise capacity, Borg Dypnea Score (BDS), New York Heart Association (NYHA) class, and clinical signs and symptoms in patients with PAH. Subsequently, multiple observational studies reported the long-term effects of subcutaneous treprostinil. The long-term survival of patients treated with subcutaneous treprostinil was similar to that reported with intravenous epoprostenol. Pain at the infusion site has been a major drawback of subcutaneous treprostinil, hampering dose titration and leading to an 8-10% discontinuation rate. In addition, studies have examined the efficacy of intravenous treprostinil in the treatment of patients with PAH. An open-label study demonstrated that intravenous treprostinil improved exercise capacity, BDS, NYHA functional class, and hemodynamics at week 12 compared with baseline. Transitioning from intravenous epoprostenol to intravenous treprostinil is safe and effective. The dose of intravenous treprostinil has to be adjusted to approximately twice the dose of intravenous epoprostenol. Most patients have reported less severe adverse effects with intravenous treprostinil compared with intravenous epoprostenol. The assessment of the long-term efficacy and safety of continuous intravenous treprostinil requires further studies.

Authors+Show Affiliations

Department of Internal Medicine II, Division of Cardiology, Vienna General Hospital, Medical University of Vienna, Währinger Gürtel 18-20, Vienna, Austria.No affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18690755

Citation

Skoro-Sajer, Nika, and Irene Lang. "The Role of Treprostinil in the Management of Pulmonary Hypertension." American Journal of Cardiovascular Drugs : Drugs, Devices, and Other Interventions, vol. 8, no. 4, 2008, pp. 213-7.
Skoro-Sajer N, Lang I. The role of treprostinil in the management of pulmonary hypertension. Am J Cardiovasc Drugs. 2008;8(4):213-7.
Skoro-Sajer, N., & Lang, I. (2008). The role of treprostinil in the management of pulmonary hypertension. American Journal of Cardiovascular Drugs : Drugs, Devices, and Other Interventions, 8(4), 213-7.
Skoro-Sajer N, Lang I. The Role of Treprostinil in the Management of Pulmonary Hypertension. Am J Cardiovasc Drugs. 2008;8(4):213-7. PubMed PMID: 18690755.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The role of treprostinil in the management of pulmonary hypertension. AU - Skoro-Sajer,Nika, AU - Lang,Irene, PY - 2008/8/12/pubmed PY - 2009/1/7/medline PY - 2008/8/12/entrez SP - 213 EP - 7 JF - American journal of cardiovascular drugs : drugs, devices, and other interventions JO - Am J Cardiovasc Drugs VL - 8 IS - 4 N2 - Pulmonary arterial hypertension (PAH) is a severely disabling disorder characterized by sustained elevations of pulmonary vascular resistance, ultimately leading to right-heart failure and death. Intravenous epoprostenol has been widely used in patients with PAH, leading to long-term clinical benefits and improved survival. Epoprostenol has to be delivered through a permanently implanted intravenous catheter, with the potential of life-threatening complications. Thus, treprostinil, a stable prostacyclin analog suitable for subcutaneous administration, has been developed. Treprostinil is chemically stable at room temperature, has a long half-life (2-4 hours), and has similar pharmacologic properties with comparable hemodynamic effects as epoprostenol.A large, double-blind, placebo-controlled, multicenter, 12-week study confirmed the efficacy of subcutaneous treprostinil, by improving exercise capacity, Borg Dypnea Score (BDS), New York Heart Association (NYHA) class, and clinical signs and symptoms in patients with PAH. Subsequently, multiple observational studies reported the long-term effects of subcutaneous treprostinil. The long-term survival of patients treated with subcutaneous treprostinil was similar to that reported with intravenous epoprostenol. Pain at the infusion site has been a major drawback of subcutaneous treprostinil, hampering dose titration and leading to an 8-10% discontinuation rate. In addition, studies have examined the efficacy of intravenous treprostinil in the treatment of patients with PAH. An open-label study demonstrated that intravenous treprostinil improved exercise capacity, BDS, NYHA functional class, and hemodynamics at week 12 compared with baseline. Transitioning from intravenous epoprostenol to intravenous treprostinil is safe and effective. The dose of intravenous treprostinil has to be adjusted to approximately twice the dose of intravenous epoprostenol. Most patients have reported less severe adverse effects with intravenous treprostinil compared with intravenous epoprostenol. The assessment of the long-term efficacy and safety of continuous intravenous treprostinil requires further studies. SN - 1175-3277 UR - https://www.unboundmedicine.com/medline/citation/18690755/The_role_of_treprostinil_in_the_management_of_pulmonary_hypertension_ L2 - https://dx.doi.org/10.2165/00129784-200808040-00001 DB - PRIME DP - Unbound Medicine ER -