Different efficacy of inhaled and oral medications in pulmonary hypertension

Abuhalimeh, Batool; Parambil, Joseph G.; Tonelli, Adriano R.

doi:10.1016/j.hrtlng.2017.04.010

Cited by 6 publications

(11 citation statements)

References 14 publications

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“…However, it remains unclear whether such agents that act on the prostacyclin pathway are equally effective whether administered orally or by inhalation. AbuHalimeh et al [ 19 ] presented two cases in which transition from inhaled treprostinil to either oral treprostinil or selexipag, resulting in worsening clinical condition and hemodynamic profile after, subsequently the hemodynamic and clinical profile improved after switched back to inhalation. These divergent responses may reflect either impaired gastrointestinal absorption with lower systemic levels of the drug and/or a preferential (local) action of the inhaled drug specifically on the pulmonary vasculature [ 19 , 20 ].…”

Section: Main Textmentioning

confidence: 99%

“…AbuHalimeh et al [ 19 ] presented two cases in which transition from inhaled treprostinil to either oral treprostinil or selexipag, resulting in worsening clinical condition and hemodynamic profile after, subsequently the hemodynamic and clinical profile improved after switched back to inhalation. These divergent responses may reflect either impaired gastrointestinal absorption with lower systemic levels of the drug and/or a preferential (local) action of the inhaled drug specifically on the pulmonary vasculature [ 19 , 20 ]. The parenteral route of treprostinil administration of (IV, SC) is bioequivalent at a steady-state, while oral treprostinil yields systemic exposure similar to that of parenteral administration with approximately 17% bioavailability.…”

Section: Main Textmentioning

confidence: 99%

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Inhaled prostacyclin analogues in COVID-19 associated acute respiratory distress syndrome: scientific rationale

Mulia

Luke

2021

Egypt Heart J

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Background COVID-19 associated acute respiratory distress syndrome (CARDS) is a severe form of SARS CoV-2 infection and affects about 15–30% of hospitalized patients with a high mortality rate. Growing research and data suggest several available drugs with appropriate pharmacological effects to treat COVID-19. Main body Prostacyclin analogues are regiments for pulmonary artery hypertension. Prostacyclin analogues are expected to be beneficial in treating CARDS based on at least four rationales: (1) inhaled prostacyclin analogues improve oxygenation, V/Q mismatch, and act as an ARDS therapy alternative; (2) it alleviates direct SARS-CoV-2-related coagulopathy; (3) increases nitric oxide production; and (4) possible anti-inflammatory effect. Prostacyclin analogues are available in oral, intravenous, and inhaled forms. The inhaled form has the advantage over other forms, such as parenteral administration risks. Previously, a meta-analysis demonstrated the beneficial effects of inhaled prostaglandins for ARDS treatment, such as improved PaO2/FiO2 and PaO2 along with reduced pulmonary artery pressure. Currently, two ongoing randomized controlled trials are evaluating inhaled epoprostenol (VPCOVID [NCT04452669]) and iloprost (ILOCOVID [NCT04445246]) for severe COVID-19 patients. Conclusions Inhaled prostacyclin could be considered in patients with refractory, life-threatening hypoxia despite standard management.

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Section: Main Textmentioning

confidence: 99%

Section: Main Textmentioning

confidence: 99%

Inhaled prostacyclin analogues in COVID-19 associated acute respiratory distress syndrome: scientific rationale

Mulia

Luke

2021

Egypt Heart J

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“…Established guidance on transitions between various formulations within this drug class have not been standardized. A number of case reports and case series have been published describing such transitions but lack consistent processes (6)(7)(8)(9)(10)(11)(12)(13).…”

Section: Introductionmentioning

confidence: 99%

“…However, despite sharing similar dosing strategies based on these recommendations, there are still numerous variations between different institutional practices. Most notable are the durations over which the transitions are implemented (6)(7)(8)(9)(10).…”

Section: Introductionmentioning

confidence: 99%

Transitioning Between Prostanoid Therapies in Pulmonary Arterial Hypertension

et al. 2020

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Background: New oral prostacyclin therapies and prostacyclin agonists have become available for the treatment of pulmonary arterial hypertension (PAH). However, methods for transitioning between oral, inhaled, and parenteral formulations are not well-established, except in the form of case reports and case series. Collectively, these emphasize the lack of a standardized process and approach in transitioning patients between PAH prostanoid therapies. In this case series, we report our experience at an accredited Pulmonary Hypertension center in transitioning between various oral, inhaled, and parenteral prostanoids to offer additional guidance on safe transitions in therapy. Methods: All cases of prostanoid transitions at an accredited Pulmonary Hypertension center from March 2018 to September 2019 were included in this report. The transition approach for each case was developed through a review of the literature, extrapolation of available pharmacokinetic data, and collaboration between pharmacists and clinicians. Results: This case series describes the transition of 3 patients from selexipag to parenteral treprostinil; 1 patient transitioning from parenteral treprostinil to selexipag; 1 patient transitioning from oral treprostinil to parenteral treprostinil; and 1 patient transitioning from inhaled treprostinil to selexipag. Four of the 6 patients presented here were transitioned to an alternate prostanoid on account of clinical worsening, while the remaining 2 patients transitioned due to intolerance of parenteral therapy and poor medication adherence. This case series includes patients with various etiologies of PAH including idiopathic PAH, methamphetamine-associated PAH, and scleroderma-associated PAH. All patients successfully completed each transition without serious adverse events. Conclusions: With the increasing utilization and availability of prostanoids, there is a critical need for a standardized approach in transitioning safely between different formulations without compromising treatment efficacy. In this case series, we present our clinical experiences, guided by available pharmacokinetic data, in transitioning between various prostanoid formulations.

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“…10 One clinical trial and 2 case reports have described the transition from inhaled treprostinil to selexipag. [11][12][13] To our knowledge, there are no published reports on transitioning a patient from inhaled iloprost to selexipag. Therefore, the purpose of this case report is to describe the successful transition of a patient with PAH from inhaled iloprost to selexipag.…”

Section: Introductionmentioning

confidence: 99%

A Case Report of a Patient With Pulmonary Arterial Hypertension Transitioned From Inhaled Iloprost to Selexipag

Verlinden

Walter

Raina

et al. 2020

Journal of Pharmacy Practice

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Pulmonary arterial hypertension (PAH) is a progressive disease characterized by elevated pulmonary vascular resistance that can lead to right ventricular failure and death. The use of medications that affect the prostacyclin pathway is an important treatment strategy in PAH. Inhaled iloprost is a prostacyclin analogue, and selexipag is an oral, non-prostanoid, prostacyclin IP receptor agonist. Data are limited on transitioning patients from inhaled iloprost to selexipag. In this case report, we describe the successful transition of a 57-year-old female with heritable PAH from inhaled iloprost to selexipag over 8 weeks in an out-patient setting. After initiation of selexipag, the patient’s inhaled iloprost dose was gradually reduced and eventually discontinued. The patient tolerated the transition well with stable symptoms, 6-minute walk distance, and pulmonary hemodynamics. Additional studies are needed to better define the comparative efficacy and safety of inhaled iloprost and selexipag.

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Different efficacy of inhaled and oral medications in pulmonary hypertension

Cited by 6 publications

References 14 publications

Inhaled prostacyclin analogues in COVID-19 associated acute respiratory distress syndrome: scientific rationale

Inhaled prostacyclin analogues in COVID-19 associated acute respiratory distress syndrome: scientific rationale

Transitioning Between Prostanoid Therapies in Pulmonary Arterial Hypertension

A Case Report of a Patient With Pulmonary Arterial Hypertension Transitioned From Inhaled Iloprost to Selexipag

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