A Multicenter, Retrospective Study Of Patients With Pulmonary Arterial Hypertension Transitioned From Parenteral Prostacyclin Therapy To Inhaled Iloprost

Channick, Richard N.; Frantz, Robert P.; Kawut, Steven M.; Palevsky, Harold I.; Tumuluri, Ramagopal; Sulica, R.; Benton, Wade W.; deBoisblanc, Ben

doi:10.1164/ajrccm-conference.2011.183.1_meetingabstracts.a5900

Cited by 6 publications

(9 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…There is conflicting evidence involving the transition from a parenteral prostacyclin analogue to an IH form. Two studies examining this transition 9,16 in patients who were on background oral PAH therapy reported success, whereas one study 17 reported clinical deterioration in a minority of patients. Therefore, clinicians should carefully discuss the risks and benefits of this particular transition with their patients and ensure close monitoring during and after the transition period.…”

Section: Discussionmentioning

confidence: 99%

“…8 At several large PAH centers, approximately 10% of patients on parenteral prostacyclin have attempted to transition to other therapies. 8,9 Typically, patients will attempt to transition therapies because of complications such as line infections 10 or vein stenosis in the case of IV therapies, site pain caused by SQ therapies, intolerable side effects from therapy, or to improve medication compliance relative to the simplicity of dosing with some newer agents.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

A systematic review of transition studies of pulmonary arterial hypertension specific medications

Sofer

Ryan²,

Tedford

et al. 2017

Pulm. circ.

View full text Add to dashboard Cite

Pulmonary arterial hypertension (PAH) is a progressive potentially fatal disease. Multiple pharmacologic options are now available, which facilitated transitions between different therapeutic options, although the evidence for such transitions has not been well described. We sought to review the evidence supporting the safety and/or efficacy of transitioning between PAH-specific medications. We performed a systematic review of all published studies in the Medline database between 1 January 2000 and 30 June 2016 reporting on any transition between the currently Food and Drug Administration (FDA)-approved PAH-specific medications. Studies reporting on three or more adult patients published in the English language reporting on transitions between FDA-approved PAH medications were extracted and tabulated. Forty-one studies met the selection criteria, nine of which included less than eight patients (and thus were reported separately in the supplement), for a total of 32 studies. Transitioning from parenteral epoprostenol to parenteral treprostinil appears to be safe and efficacious in patients who have less severe disease and more favorable hemodynamics. Transitioning from a prostacyclin analogue to an oral medication may be successful in patients who have favorable hemodynamics and stable disease. There is conflicting evidence supporting the transition from a parenteral to an inhaled prostacyclin analogue, even in patients who are on background oral therapy. Currently, the only evidence in support of transitioning between oral PDE5 inhibitors is from sildenafil to tadalafil. Patients on higher doses of sildenafil are more likely to fail. In patients with liver abnormalities due to bosentan or sitaxentan, the transition to ambrisentan appears to be safe and can result in clinical improvement. Studies regarding PAH medication transitions are limited. Patients who have less severe disease, better functional status, and are on lower medications doses may be more successful at transitioning.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A systematic review of transition studies of pulmonary arterial hypertension specific medications

Sofer

Ryan²,

Tedford

et al. 2017

Pulm. circ.

View full text Add to dashboard Cite

show abstract

“…Patients in these studies were switched either because of drug-related AEs, because clinical improvement during PCA therapy allowed a switch to a non-intravenous formulation, or to achieve a more convenient administration schedule when switching between inhaled PCAs. [25][26][27] Other studies have assessed switching from a prostanoid to an ERA such as bosentan 28 or a PDE5i such as sildenafil. 29 These studies demonstrated a prolonged and stable functional class, and improved 6minute walking distance (6MWD) and quality of life.…”

Section: Studies Of Switching Between Pah-approved Therapiesmentioning

confidence: 99%

Switching to riociguat: a potential treatment strategy for the management of CTEPH and PAH

et al. 2020

View full text Add to dashboard Cite

Currently, five classes of drug are approved for the treatment of pulmonary arterial hypertension (PAH): phosphodiesterase 5 inhibitors (PDE5i); endothelin receptor antagonists; prostacyclin analogs; the IP receptor agonist selexipag; and the soluble guanylate cyclase (sGC) stimulator riociguat. For patients with inoperable or persistent/recurrent chronic thromboembolic pulmonary hypertension (CTEPH), riociguat is currently the only approved pharmacotherapy. Despite the development of evidence-based guidelines on appropriate use of specific drugs, in clinical practice patients are often prescribed PAH-targeted therapies off label or at inadequate doses. PDE5i are the most often prescribed class of drugs as initial therapy, either alone or in combination with other drug classes. However, a proportion of patients receiving PAH therapies do not reach or maintain treatment goals. As PDE5i and riociguat target different molecules in the nitric oxide-sGC-cyclic guanosine monophosphate (NO-sGC-cGMP) signaling pathway, for patients with PAH without an initial or sustained response to PDE5i, there is a biological rationale for switching to riociguat. However, robust data from randomized controlled trials on the safety and efficacy of switching are lacking, as is formal guidance for clinicians. Here we review studies of sequential combination therapy, and trial data and case studies that have investigated switching between PAH-approved therapies, particularly from PDE5i to riociguat in patients with PAH with an insufficient response to PDE5i, and in patients with CTEPH who were receiving off-label treatment. These studies summarize the current evidence and practical real-life experience on the concept of switching treatments.

show abstract

“…Inhaled formulations have been used with success in patients who have complications or cannot tolerate parenteral prostacyclin analogs. 87 Being newer medications, there is less clinical and research experience with treprostinil and iloprost than epoprostenol, and it is not well-described if there are ''super responders'' to these therapies.…”

Section: Prostacyclin Analoguesmentioning

confidence: 99%

Identifying “super responders” in pulmonary arterial hypertension

Halliday

Hemnes

2017

Pulm. circ.

View full text Add to dashboard Cite

Pharmacotherapeutic options for pulmonary arterial hypertension (PAH) have increased dramatically in the last two decades and along with this have been substantial improvements in survival. Despite these advances, however, PAH remains a progressive and ultimately fatal disease for most patients and only epoprostenol has been shown to improve survival in a randomized control trial. Clinical observations of the heterogeneity of treatment response to different classes of medications across the phenotypically diverse PAH population has led to the identification of patients who derive significantly more benefit from certain medications than the population mean, the so-called “super responders.” This was first recognized among PAH patients with acute vasodilator response during invasive hemodynamic testing, a subset of whom have dramatically improved survival when treated with calcium channel blocker (CCB) therapy. Retrospective studies have now suggested a sex discrepancy in response to endothelin receptor antagonists (ERA) and phosphodiesterase inhibitors, and more recently a few studies have found genomic associations with response to CCBs and ERAs. With increasing availability of “omics” technologies, recognition of these “super responders,” combined with careful clinical and molecular phenotyping, will lead to advances in pharmacogenomics, precision medicine, and continued improvements in survival among PAH patients.

show abstract

A Multicenter, Retrospective Study Of Patients With Pulmonary Arterial Hypertension Transitioned From Parenteral Prostacyclin Therapy To Inhaled Iloprost

Cited by 6 publications

References 14 publications

A systematic review of transition studies of pulmonary arterial hypertension specific medications

A systematic review of transition studies of pulmonary arterial hypertension specific medications

Switching to riociguat: a potential treatment strategy for the management of CTEPH and PAH

Identifying “super responders” in pulmonary arterial hypertension

Contact Info

Product

Resources

About