Implantable system for treprostinil: a real‐world patient experience study

Abstract

Parenteral prostanoids are effective for improving outcomes in patients with pulmonary arterial hypertension. However, subcutaneous or intravenous delivery via an external pump places a significant burden on patients. Consequently, the Implantable System for Remodulinß (treprostinil) was developed and is associated with a low rate of complications (United Therapeutics (Research Triangle Park, NC) in collaboration with Medtronic, Inc. (Mounds View, MN)). The current real-world experience study evaluated pulmonary arterial hypertension patients' perceptions of their quality of life, ability to perform activities of daily living, perceptions on the benefits and risks of the implantable system, and their social interactions before and after receiving the implantable system. Pulmonary arterial hypertension patients who had been transitioned from an external infusion pump to the implantable system completed a mix of quantitative and qualitative questions administered online over the course of a six-day period. A total of 20 patients completed the study. All patients reported that their quality of life, confidence out in public, and ability to travel long distances had improved. Over 90% of patients reported that their overall level of independence was better since receiving the implantable system, and most patients indicated that their ability to independently perform specific activities of daily living had improved. Responses to the qualitative questions suggested that the implantable system saved time, improved interpersonal relationships, and increased freedom. Results from this real-world patient experience study suggest this novel delivery system provides improvements in factors that are of substantial importance to patients.

Management of Idiopathic Pulmonary Arterial Hypertension in a Patient in Trinidad: A Case Report

“…However, studies reveal local and systemic treprostinil-related reactions after refilling and cases of pump failure [ 1 , 16 ]. Similar to the participants of the DellVery study, our patient was satisfied with her IDS for intravenous treprostinil [ 18 , 19 ].…”

“…It represents a beneficial alternative to previously used external pumps as it yields a 44-fold reduction of catheter-related severe bloodstream infections and a reduction of catheter thrombosis, occlusions, or kinks, as revealed by the DellVery study [ 16 , 17 ]. Moreover, patients experience a higher quality of life, such as taking showers without concern for getting the pump wet, sleeping without fear of catheter dislocation, reduced frequency of refillings, and reduced stigmatizations associated with the visibility of external pumps [ 16 - 18 ]. However, studies reveal local and systemic treprostinil-related reactions after refilling and cases of pump failure [ 1 , 16 ].…”

“…In surgical management, transplantation is an option for eligible patients with severe disease refractory to maximal medical therapy. Interventional procedures, such as balloon atrial septostomy (BAS), are considered a temporizing measure for patients awaiting transplantation or without access to medical therapy [1,10,[12][13][14][15][16][17][18][19][20][21][22][23]. Our patient adopted the general measures advised by her physician corroborated in the literature, which indicates avoiding strenuous physical activity [8,10]; recommends avoiding pregnancy (associated with a very high maternal mortality rate) [4,8,10]; recommends influenza and pneumococcal vaccinations (pneumonia is the cause of death in 7% of PAH cases) [8,10].…”

“…The only prostacyclin currently used with the IDS system is treprostinil due to its long-term thermal stability compared to epoprostenol, which is considered the most effective therapy as it is the only PAH-targeted therapy to have shown improved survival in a randomized controlled trial [1,4,[16][17][18][19]. Notwithstanding, the result of another trial elucidates that continuous subcutaneous treprostinil, in addition to conventional therapy, is effective in IPAH patients as measured by improvements in exercise capacity, hemodynamics and symptoms when compared to those treated with conventional therapy alone [1,20].…”

Novel Treatment Pathways in Pulmonary Arterial Hypertension

“… 35 , 36 This system, which has shown to save time and increase independence and quality of life, is awaiting final FDA approval. 37 …”