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

Abstract

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.

Evaluation of the Efficacy and Safety of Inhaled Epoprostenol and Inhaled Nitric Oxide for Refractory Hypoxemia in Patients With Coronavirus Disease 2019

“…Although there were only 11 patients that transitioned to iNO, there was a similar observed change in Pa o 2 /F io 2 . These results are different from what previous studies have shown when inhaled vasodilators have been used for refractory hypoxemia in ARDS unrelated to COVID-19 ( 8 , 9 ).…”

“…Several analyses comparing both agents have shown iEPO to be noninferior to iNO in patients with ARDS regarding safety, changes in oxygenation, and improvement in clinical outcomes, such as ventilator-free days ( 8 , 10 , 25 ). It is unclear if and how ARDS in patients with COVID-19 differs, but we saw less of an improvement in oxygenation metrics compared with previous studies ( 8 , 9 , 26 ). Our patients had significant differences at baseline, specifically decreased use of corticosteroids and increased use of neuromuscular blockade and prone-positioning, compared with previous studies evaluating ARDS unrelated to COVID-19 ( 9 , 26 ).…”

“…It is unclear if and how ARDS in patients with COVID-19 differs, but we saw less of an improvement in oxygenation metrics compared with previous studies ( 8 , 9 , 26 ). Our patients had significant differences at baseline, specifically decreased use of corticosteroids and increased use of neuromuscular blockade and prone-positioning, compared with previous studies evaluating ARDS unrelated to COVID-19 ( 9 , 26 ). Early data described risk factors of developing ARDS in patients with COVID-19 that included elevated inflammation-related indices such as C-reactive protein and ferritin ( 27 ).…”

Inhaled pulmonary vasodilators: a narrative review

“…It is effective in reducing pulmonary pressures and increasing oxygenation by improving V/Q matching, and has minimal adverse events (146)(147)(148)(149). More importantly, depending on the institution's contracted price, the use of iEPO is associated with significant savings, and there is no difference between Flolan and Veletri (150,151).…”

In-vitro and in-vivo comparisons of high versus low concentrations of inhaled epoprostenol to adult intubated patients

“…Inhaled epoprostenol (iEPO), a naturally occurring prostaglandin that acts as vascular smooth muscle relaxant, has been utilized clinically for over two decades and has been shown to reduce pulmonary artery pressure [ 1 – 5 ] and improve oxygenation [ 3 – 12 ]. Despite its clinical significance, an optimal delivery strategy remains unknown.…”