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Effect of Earlier Initiation of Inhaled Treprostinil (iTRE) on Long Term Outcomes in Patients with Pulmonary Arterial Hypertension (PAH)

Raymond Benza


S. K. Gotzkowsky

A. Jenkins

Lewis Rubin


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Conference: 2012 International PHA Conference and Scientific Sessions

Release Date: 06.22.2012

Presentation Type: Abstracts

R Benza1; K Gotzkowsky2; A Jenkins2; L Rubin3

1. Allegheny General Hospital, Pittsburgh, PA
2. United Therapeutics Corp., Research Triangle Park, NC
3. UCSD Medical Center, San Diego, CA

PURPOSE: Current PAH treatment algorithms encourage a stepwise, add-on approach. At present, the ideal time to add-on prostacyclin therapy remains unknown. TRIUMPH-1 was a 12-week double blind (DB) trial of iTRE in patients stabilized on an oral background therapy with a long term open-label (OL) extension. This analysis compares efficacy outcomes up to 2 years with OL iTRE in patients originally assigned in DB to iTRE (iTRE/ iTRE) or PBO (PBO/ iTRE).

METHODS: 206 subjects (125 US, 81 Rest of World) participated in OL. Six minute walk distance (6MWD), quality of life (MLwHF), and NYHA functional class were assessed every 3 months. Exposure time for all patients was calculated based on time on active iTRE.

RESULTSMedian baseline 6MWD was 359 meters for 97 patients receiving iTRE/iTRE and 365 meters for 109 patients receiving PBO/iTRE. Marked improvements in 6MWD were noted in iTRE/ iTRE as compared with PBO/ iTRE, with median changes of 37, 38, 35 and 26 meters vs. 19, 25, 22, and 5 meters at 6, 12, 18, and 24 months respectively. After 18 and 24 months of therapy respectively, 45% and 38% iTRE/iTRE had improvements in 6MWD of >50m compared to 32% and 27% in PBO/iTRE. A greater frequency of improvement in components of MLwHF was also noted in iTRE/iTRE, as were decreases in functional class (FC) at 24 months compared to baseline (42% iTRE/iTRE vs. 30% PBO/iTRE).

CONCLUSIONS: PAH is a progressive disease often requiring multiple therapies. These data obtained in patients stabilized on an oral PAH medication suggest that the earlier addition of inhaled treprostinil provides long-term improvement in exercise capacity and QOL, while also demonstrating the potential outcome of delaying active therapy in placebo controlled trials.

FUNDING:  United Therapeutics Corp