Transition of Intravenous Treprostinil to Oral Therapy in a Patient with Functional Class <scp>IV</scp> Chronic Thromboembolic Pulmonary Hypertension

Thurber, Kristina M.; WILLIAMS, B; Bates, Ruth; Frantz, Robert P.

doi:10.1002/phar.1951

Cited by 12 publications

(13 citation statements)

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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%

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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Section: Introductionmentioning

confidence: 99%

Transitioning Between Prostanoid Therapies in Pulmonary Arterial Hypertension

et al. 2020

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“…[5][6][7][8] Favorable outcomes have been described in those transitioned from an alternate route of administration (IV, SQ, and inhaled) to treprostinil diolamine. [9][10][11][12][13] We describe 3 patients who were transitioned from an alternate treprostinil route to treprostinil diolamine as well as a summary of the literature to date on this therapeutic approach.…”

Section: Introductionmentioning

confidence: 99%

“…Five publications were identified that included a case report, 3 case series, and a prospective, openlabel study. [9][10][11][12][13] These publications describe the transition of 48 patients (36 females and 12 males) to treprostinil diolamine. Of these, 32, 12, and 4 patients were receiving SQ, IV, or inhaled treprostinil, respectively (Table 3).…”

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confidence: 99%

“…Of these, 32, 12, and 4 patients were receiving SQ, IV, or inhaled treprostinil, respectively (Table 3). [9][10][11][12][13] Forty-four (92%) were meeting clinical end points (functional class I/II) and 47 (98%) were receiving at least 1 other PAH medication at the time of transition. The rationale for transition to treprostinil diolamine was reported in 3 of the 5 publications and included patient preference (n ¼ 9), SQ infusion site pain (n ¼ 4), inability to transfer to long-term care facility (n ¼ 1), and catheter infection (n ¼ 1).…”

mentioning

confidence: 99%

“…The rationale for transition to treprostinil diolamine was reported in 3 of the 5 publications and included patient preference (n ¼ 9), SQ infusion site pain (n ¼ 4), inability to transfer to long-term care facility (n ¼ 1), and catheter infection (n ¼ 1). 10,12,13 The baseline parenteral treprostinil doses ranged from 20 to 111 ng/kg/min. [9][10][11][12][13] The TDD of treprostinil diolamine after transition ranged from 12 to 75 mg. [9][10][11][12][13] After the transition period, treprostinil diolamine dosing regimens of 2, 3, and 4 times per day were used in 8 (17%), 37 (77%), and 3 (6%) patients, respectively.…”

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confidence: 99%

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Transitioning Parenteral or Inhaled Treprostinil to Oral Treprostinil Diolamine: Case Series and Review of the Literature

Smith

Kelly

Awdish

et al. 2018

Journal of Pharmacy Practice

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Treprostinil diolamine is the first oral dosage preparation of a prostacyclin analogue for use in treatment naive pulmonary arterial hypertension (PAH). This case series and review of the available literature describes the experience of patients with PAH receiving treprostinil by intravenous (IV), subcutaneous (SQ), or inhalation route who were transitioned to treprostinil diolamine. At our institution, 3 patients were transitioned to treprostinil diolamine who received treprostinil administered by each of the alternative routes: IV, SQ, and inhalation. All patients tolerated the transition without significant worsening of disease end points. In the literature, 5 additional reports representing 48 patients were transitioned to treprostinil diolamine from an alternate route of administration. A majority (92%) of patients were hospitalized during the cross-titration phase and tolerated the transition without changes in disease markers or significant adverse effect. Six (13%) patients required reinitiation of parenteral therapy due to clinical decline. The most common dosing frequency utilized for treprostinil diolamine was 3 times per day. In patients with stable PAH receiving parenteral or inhaled treprostinil, a transition to treprostinil diolamine was a safe approach in a highly select population meeting clinical end points. Additional studies are required to further describe this clinical strategy before accepted in clinical practice.

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Opportunities and challenges of pharmacotherapy for pulmonary arterial hypertension in children

Kam

Ruiz

2020

Pediatric Pulmonology

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Pediatric pulmonary hypertension (PAH) is a rare disease that carries a poor prognosis if left untreated. Although there are published guidelines for the treatment of children with pulmonary hypertension, due to the limited number of robust pediatric clinical trials, recommendations are often based on limited data or clinical experience. Furthermore, many practical aspects of care, particularly for the pediatric patient, are learned through experience and best navigated with a multidisciplinary team. While newer PAH therapies have been approved for adults, there is still limited but expanding experience in pediatrics. This new information will help improve the targets of goal‐oriented therapy. Lastly, this review highlights practical aspects in the use of the different therapies available for the treatment of pediatric pulmonary hypertension.

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Transition of Intravenous Treprostinil to Oral Therapy in a Patient with Functional Class IV Chronic Thromboembolic Pulmonary Hypertension

Cited by 12 publications

References 11 publications

Transitioning Between Prostanoid Therapies in Pulmonary Arterial Hypertension

Transitioning Between Prostanoid Therapies in Pulmonary Arterial Hypertension

Transitioning Parenteral or Inhaled Treprostinil to Oral Treprostinil Diolamine: Case Series and Review of the Literature

Opportunities and challenges of pharmacotherapy for pulmonary arterial hypertension in children

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