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Outpatient Transition of Parenteral to Oral Prostacyclin in Pulmonary Arterial Hypertension

KL Morris

Aaron Kelkhoff

Ann Schmit

Ashwin Ravichandran

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Conference: 2018 PHA International PH Conference & Scientific Sessions

Release Date: 06.28.2018

Presentation Type: Abstracts

File Download: Conference 2018_1072

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2018 International PH Conference and Scientific SeAbstract presented at the 2018 International PH Conference and Scientific Sessions in Orlando, Fla., June 28-July 1, 2018.

Background

Pulmonary arterial hypertension (PAH) is a progressive, incurable disease with a rapidly progressing number of treatment options. Traditionally, prostacyclin therapies have been underutilized (1). Now with oral formulations available such as treprostinil, increased access to this important therapeutic pathway may improve patient outcomes, inclusive of quality of life and cost. (2,3) One strategy has been to transition patients from parenteral to oral prostacyclin therapy through a 5 day inpatient hospitalization regimen in 33 patients (4). We seek to describe our experience through a more rapid inpatient or outpatient based transition.

Methods

We retrospectively reviewed charts for those transitioned from parenteral to oral treprostinil within St. Vincent Medical Group in Indianapolis, IN between in 2017-18. Charts were extensively analyzed for baseline data, including transthoracic echocardiogram and hemodynamics, along with outcome analysis before and after treprostinil transition.

Results

Six patients were transitioned from parenteral to oral prostacyclin therapy within a rapid 2-5 day observation admission or outpatient setting. Table 1 illustrates our 3 patients that have Group 1 pulmonary arterial hypertension on double or triple therapy with the prostacyclin. Transitions were safe and successful in all patients.

Conclusions

Based on our limited experience, it is safe to rapidly transition patients from parenteral to oral treprestinil in an outpatient fashion while maintaining functional status, ease of administration, cost and quality of life for the patient and health system.

References: 

1. Badesch et al. Pulmonary Arterial Hypertension: Baseline Characteristics from the REVEAL registry. CHEST. 2010. 137: 376-387.

2. Jing et al. Efficacy and safety of oral treprostinil monotherapy for the treatment of pulmonary arterial hypertension: a randomized, controlled trial. Circulation. 2013; 127 (5): 624-33.

3. Tapson et al. Oral treprostinil for the treatment of pulmonary arterial hypertension in patients on background endothelian receptor antagonist and/or phosphodiesterase type 5 therapy; a randomized controlled trial. Chest. 2012; 142(6): 1383.

4. Chakinala, et al. Transition from parenteral to oral treprostinil in pulmonary arterial hypertension. J Heart Lung Transplant. 2017; 36; 193-201.

 

Table 1: Outpatient (Patients 1-3) and rapid inpatient (Patients 4-6) transition from parenteral to oral treprostinil.