Transition from intravenous epoprostenol to intravenous treprostinil in pulmonary hypertension
| Autor: | Mardi Gomberg-Maitland, Abigail Krichman, Victor F. Tapson, Raymond L. Benza, Vallerie V. McLaughlin, Allison C. Widlitz, Robyn J. Barst |
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| Rok vydání: | 2005 |
| Předmět: |
Pulmonary and Respiratory Medicine
Adult Male medicine.medical_specialty Resuscitation Adolescent Hypertension Pulmonary Bioequivalence Critical Care and Intensive Care Medicine Intensive care medicine Humans Child Infusions Intravenous Antihypertensive Agents Aged Cross-Over Studies Exercise Tolerance business.industry Respiratory disease Middle Aged medicine.disease Pulmonary hypertension Crossover study Epoprostenol respiratory tract diseases Surgery Clinical trial Treatment Outcome Anesthesia Female business Treprostinil medicine.drug |
| Zdroj: | American journal of respiratory and critical care medicine. 172(12) |
| ISSN: | 1073-449X |
| Popis: | 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.To evaluate the safety and efficacy of transitioning patients with pulmonary arterial hypertension from intravenous epoprostenol to intravenous treprostinil.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.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, p0.01), 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, p0.01). No serious adverse events were attributed to treprostinil.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. |
| Databáze: | OpenAIRE |
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