Effectiveness, safety, and Economic Comparison of Two Inhaled Epoprostentol Products (Flolan and Veletri) in Cardiothoracic Surgery Patients

Hawn, Jaclyn M.; Wanek, Matthew; Bauer, Seth; Ammar, Mahmoud; Insler, Steven R.; Adi, Ahmad; Torbic, Heather

doi:10.1177/1060028018776432

Cited by 8 publications

(16 citation statements)

References 16 publications

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“…However, through manual chart review we did not find any mention of increased intolerance or airway inflammation with inhaled Veletri therapy, which is in line with the findings from other studies that have evaluated inhaled Veletri use in an adult patient population. 7,19 Finally, more patients who received inhaled Veletri developed thrombocytopenia and required platelet transfusions than patients who received inhaled Flolan, but patients who received inhaled Veletri had significantly lower platelet counts at baseline, and we believe that this is unlikely to be an effect of Veletri.…”

Section: Discussionmentioning

confidence: 87%

“…Patients who received inhaled Veletri had a shorter duration of mechanical ventilation, less frequent dialysis initiation, and a decreased cost per median duration of inhaled epoprostenol compared with patients who received inhaled Flolan. 19 The differences in secondary outcomes were attributed to a change in practice at their institution rather than to differences between inhaled epoprostenol formulations. The lack of inclusion of ARDS patients in the study makes the extrapolation of these findings to our study limited.…”

Section: Discussionmentioning

confidence: 99%

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Effectiveness, Safety, and Economic Comparison of Inhaled Epoprostenol Brands, Flolan and Veletri, in Acute Respiratory Distress Syndrome

et al. 2019

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Background: No previous studies exist examining 2 inhaled epoprostenol formulations in an acute respiratory distress syndrome (ARDS) patient population. Objective: The study aim was to evaluate a formulary conversion from inhaled Flolan to Veletri to determine the impact on effectiveness, safety, and cost in patients with ARDS. Methods: This was a single-center, retrospective, matched cohort observational study at a tertiary care academic medical center. Patients included were mechanically ventilated, adult patients with ARDS receiving inhaled Flolan or Veletri for ≥1 hour in the intensive care unit. Results: A total of 132 patients were included in the matched cohort. There was no difference detected in change in partial pressure of arterial O2/fraction of inspired O2 (PaO2/FiO2) ratio after 1 hour of therapy between the inhaled Flolan and Veletri groups (27.2 ± 46.2 vs 30 ± 68 mm Hg, P = 0.78). Significant differences in secondary outcomes included incidence of hypotension (83% vs 95.5%, P = 0.04) and thrombocytopenia (9.1% vs 29.5%, P < 0.01) in the inhaled Flolan and Veletri groups, respectively, with no difference in cost per duration of therapy ( P = 0.29). Conclusions and Relevance: There was no difference in the change in PaO2/FiO2 ratio after 1 hour of therapy between inhaled Flolan and Veletri in an ARDS patient population. The formulary conversion from inhaled Flolan to Veletri was likely justified.

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Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Effectiveness, Safety, and Economic Comparison of Inhaled Epoprostenol Brands, Flolan and Veletri, in Acute Respiratory Distress Syndrome

et al. 2019

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“…60,[74][75][76]78 The epoprostenol product, Veletri, has a theoretically greater risk of bronchospasm compared to the Flolan product due to the arginine component in the inactive ingredients of Veletri, although this has not been reported when Veletri has been studied in critically ill patients. 80,81 There is an increased potential for medication errors when prescribing, preparing, and administering epoprostenol via the inhalation route since it is an IV product. Special safety measures should be taken to prevent inadvertent IV administration.…”

Section: Inhaled Formulationsmentioning

confidence: 99%

Management of Pulmonary Arterial Hypertension in the ICU

Torbic

2019

Journal of Pharmacy Practice

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Patients with pulmonary arterial hypertension (PAH) who are admitted to the intensive care unit (ICU) pose a challenge to the multidisciplinary health-care team due to the complexity of the pathophysiology of their disease state and the medication considerations that must be made to appropriately manage them. PAH is a progressive disease with the majority of patients ultimately dying as a result of right ventricular (RV) failure. During an acute decompensation, patients must be appropriately managed to optimize volume status, RV function, cardiac output, and systemic perfusion, while treating the underlying cause of the exacerbation. During times of critical illness, the ability to administer medications approved for use in PAH can be impacted by end-organ damage, hemodynamic instability, new drug interactions, or available dosage forms. Balancing the multimodal treatment approach needed to manage an acute exacerbation and the pharmacokinetic and administration concerns impacting baseline PAH therapy as a result of critical illness requires an expert multiprofessional PAH team. The purpose of this review is to evaluate specific management considerations for critically ill patients with PAH in the ICU.

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“…63 Administration of iEPO (Veletri) exposes patients to increased concentrations of arginine, potentially leading to bronchospasm and respiratory distress; however, in recent studies, the effects of Flolan and Veletri were comparable in regard to improvements in PaO 2 :FiO 2 without differences in risks. 78,79 Dosing of iEPO has been described as a fixed-dose or weight-based dose by ideal body weight. A fixed-dose strategy requires a change in concentration for each dose titration, whereas a weight-based dosing strategy offers the convenience of a standardized concentration with dose titration allowed by changing the rate and gas flow to the nebulizer.…”

Section: Inhaled Pulmonary Vasodilators Impact On Oxygenation Parametmentioning

confidence: 99%

Section: Inhaled Pulmonary Vasodilatorsmentioning

confidence: 99%

Moderate to Severe Acute Respiratory Distress Syndrome Management Strategies: A Narrative Review

Buckley

Dzierba

Muir

et al. 2019

Journal of Pharmacy Practice

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Acute respiratory distress syndrome (ARDS) remains a common complication associated with significant negative outcomes in critically ill patients. Lung-protective mechanical ventilation strategies remain the cornerstone in the management of ARDS. Several therapeutic options are currently available including fluid management, neuromuscular blocking agents, prone positioning, extracorporeal membrane oxygenation, corticosteroids, and inhaled pulmonary vasodilating agents (prostacyclins and nitric oxide). Unfortunately, an evidence-based, standard-of-care approach in managing ARDS beyond lung-protective ventilation remains elusive, contributing to significant variability in clinical practice. Although the optimal therapeutic strategy for managing moderate to severe ARDS remains extremely controversial, therapies supported with more robust clinical evidence should be considered first. The purpose of this narrative review is to discuss the published clinical evidence for both pharmacologic and nonpharmacologic management strategies in adult patients with moderate to severe ARDS as well as to discuss practical considerations for implementation.

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Effectiveness, safety, and Economic Comparison of Two Inhaled Epoprostentol Products (Flolan and Veletri) in Cardiothoracic Surgery Patients

Abstract: Inhaled Veletri was demonstrated to be non-inferior to inhaled Flolan when comparing change in PaO/FiO ratio 1 hour post -therapy initiation,and inhaled Veletri was an acceptable alternative to inhaled Flolan in a cardiothoracic surgery patient population.

Cited by 8 publications

References 16 publications

Effectiveness, Safety, and Economic Comparison of Inhaled Epoprostenol Brands, Flolan and Veletri, in Acute Respiratory Distress Syndrome

Effectiveness, Safety, and Economic Comparison of Inhaled Epoprostenol Brands, Flolan and Veletri, in Acute Respiratory Distress Syndrome

Management of Pulmonary Arterial Hypertension in the ICU

Moderate to Severe Acute Respiratory Distress Syndrome Management Strategies: A Narrative Review

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