Transition From Prostacyclin to Bosentan in Five Patients With Severe Pulmonary Hypertension: the Switch Is Possible

Camacho, Ángela Flox; Escribano, Pilar; Meneses, Rocío Tello de; Jiménez, Juan Delgado; Sánchez, Miguel; Calzada, Carlos Sáenz de la

doi:10.1016/s1885-5857(07)60033-4

Cited by 3 publications

(11 citation statements)

References 9 publications

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“…Different protocols to transition patients from prostacyclin analogue infusion to oral therapy have been used, [13][14][15][16][17][18] and there are no guidelines to safely achieve this transition. Most of the reported protocols were done on an outpatient basis and used a fixed-interval or fixed-dose weaning schedule, [13][14][15][16] sometimes with adjustments on the basis of symptoms. 16 Our protocol consisted of a symptomand hemodynamic-guided weaning process that was tailored to each patient.…”

Section: Discussionmentioning

confidence: 99%

“…[13][14][15] This difference in transition length may be explained by the type of protocol we used or simply by the fact the mean prostacyclin analogue dose before transition was higher in our study. 13,14,16,17 It has been shown that the rate of initial success after attempted transition from prostacyclin infusion to oral therapy ranges from 45% to 100%; [13][14][15][16][17][18][19][20] however, long-term success may be limited. 13,15,19 Suleman and Frost 19 and Steiner et al 15 reported a success rate of 65% and 45%, respectively, while only 40% and 32% of their patients remained off prostacyclin infusion at 12 months.…”

Section: Discussionmentioning

confidence: 99%

“…Most of the reported protocols were done on an outpatient basis and used a fixed-interval or fixed-dose weaning schedule, 13–16 sometimes with adjustments on the basis of symptoms. 16 Our protocol consisted of a symptom- and hemodynamic-guided weaning process that was tailored to each patient. The length of the transition period varied widely among the prior studies, ranging from as low as 6.6 weeks 16 to up to 3.4 years in pediatric patients.…”

Section: Discussionmentioning

confidence: 99%

“…16 Our protocol consisted of a symptom- and hemodynamic-guided weaning process that was tailored to each patient. The length of the transition period varied widely among the prior studies, ranging from as low as 6.6 weeks 16 to up to 3.4 years in pediatric patients. 18 In our study, the mean duration of transition was longer than that in most of the prior studies in the adult population (16 vs. 4–12 months).…”

Section: Discussionmentioning

confidence: 99%

“…It has been shown that the transition can be achieved without compromising hemodynamic status. [13][14][15][16][17][18][19][20][21] However, the predictors of successful transition and long-term outcomes are not known. In this study, we compared clinical and hemodynamic data in PAH patients with or without successful transition from intravenous prostacyclin to oral therapy and evaluated the potential predictors of successful transition.…”

Section: Introductionmentioning

confidence: 99%

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Transition from Prostacyclin Analogue Infusion to Oral Therapy in Patients with Pulmonary Arterial Hypertension: A 5‐Year follow‐up

et al. 2013

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Transition from prostacyclin analogue infusion to oral therapy in patients with pulmonary arterial hypertension (PAH) is possible with acceptable short- and midterm results. However, there is a paucity of data on long-term outcomes after successful transition. Using a predefined protocol, transition to oral therapy was attempted in 22 patients with clinically stable PAH. Clinical and hemodynamic data were retrospectively collected at baseline as well as during and after transition. Parameters for successful versus nonsuccessful transition were also evaluated. All patients had severe PAH at baseline and showed clinical and hemodynamic improvement with prostacyclin analogue infusion. Initial oral agents used for transition were bosentan (63.6%), sildenafil (31.8%), and tadalafil (4.5%). Combination therapy was used in 68% of the patients. Successful transition was achieved in 11 patients (50%) with a mean transition duration of 16 months. After successful transition, clinical and hemodynamic parameters remained stable at midterm (mean, 18 months) and long-term (mean, 60 months) follow-up. Compared with the successful transition group, patients who experienced failure were older, had a higher frequency of idiopathic PAH, and had worse hemodynamic parameters during treatment with prostacyclin analogue alone, as well as during the transition period. In conclusion, successful transition from prostacyclin analogue infusion to oral therapy can be achieved in a significant proportion of patients with clinically stable PAH. After an initial successful transition, patients were able to maintain clinical and hemodynamic stability at the mid- and long-term follow-up.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Transition from Prostacyclin Analogue Infusion to Oral Therapy in Patients with Pulmonary Arterial Hypertension: A 5‐Year follow‐up

et al. 2013

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

Sofer

Ryan²,

Tedford

et al. 2017

Pulm. circ.

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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.

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Pulmonary arterial hypertension related to human immunodeficiency virus infection: A case series

Araújo¹,

Enjuanes-Grau²,

Lopez-Guarch³

et al. 2014

WJC

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Transition From Prostacyclin to Bosentan in Five Patients With Severe Pulmonary Hypertension: the Switch Is Possible

Cited by 3 publications

References 9 publications

Transition from Prostacyclin Analogue Infusion to Oral Therapy in Patients with Pulmonary Arterial Hypertension: A 5‐Year follow‐up

Transition from Prostacyclin Analogue Infusion to Oral Therapy in Patients with Pulmonary Arterial Hypertension: A 5‐Year follow‐up

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

Pulmonary arterial hypertension related to human immunodeficiency virus infection: A case series

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