Home
|
Inbox
|
Search
|
View Abstract
Successful Outpatient Transition from Intravenous Treprostinil to Oral Selexipag
Description
.abstract img { width:300px !important; height:auto; display:block; text-align:center; margin-top:10px } .abstract { overflow-x:scroll } .abstract table { width:100%; display:block; border:hidden; border-collapse: collapse; margin-top:10px } .abstract td, th { border-top: 1px solid #ddd; padding: 4px 8px; } .abstract tbody tr:nth-child(even) td { background-color: #efefef; } .abstract a { overflow-wrap: break-word; word-wrap: break-word; }
A7018 - Successful Outpatient Transition from Intravenous Treprostinil to Oral Selexipag
Author Block: L. M. Kimmig, R. Bag; Section of Pulmonary and Critical Care Medicine, The University of Chicago, Chicago, IL, United States.
Introduction
Treatment modalities for World Health Organization (WHO) Group 1 pulmonary arterial hypertension (PAH) frequently include prostanoids. The drug delivery for medications of this class of medication was cumbersome and limited to continuous intravenous (IV) or subcutaneous infusion until recently. Inhaled and oral prostacyclin analogues and an oral prostacyclin receptor agonist have become available. We report the case of the successful ambulatory transition from IV treprostinil to oral selexipag in a patient at our Pulmonary Hypertension (PH) Center.
Case Report
A 62 year-old female with WHO Group 1 idiopathic PAH was followed in our PH Center and managed with tadalafil 40 mg daily, ambrisentan 5 mg daily, and treprostinil 104 ng/kg/min by continuous intravenous infusion. The patient expressed interest in transitioning away from injectable prostanoid therapy. She had been on IV treprostinil for 126 months prior to transition, including 111 months at her current rate. Over the course of 71 days, the patients IV treprostinil was decreased every 1-2 weeks as her selexipag was up-titrated to 1,600 mg twice daily. The patient was followed with regular phone calls during this time. The patient’s ambrisentan was also increased to 10 mg daily. The patient tolerated the transition well and her symptoms corresponded to WHO Functional Class 2 both before and after transition. Her 6-minute walk distance increased slightly from 1,493 feet to 1,506 feet. NT-proBNP decreased from 780 pg/ml to 438 pg/ml. On right heart catheterization, her pulmonary artery pressure decreased from 70/37 mmHg (mean 48 mmHg) to 52/28 mmHg (mean 36 mmHg). Cardiac output decreased slightly from 6.5 l/min to 5.7 l/min and PVR decreased from 5.4 Wood units to 4.9 Wood units. The patient reported diarrhea and mild jaw pain as side effects of her new therapy regimen after transition. She has not been hospitalized at our institution since her transition.
Discussion
Transitioning from injectable prostanoids to inhaled or oral formulations has previously been described. In the published literature, patients have typically been admitted to the hospital for the transition. We describe the successful outpatient transition from the intravenous prostacyclin analogue treprostinil to the oral prostacyclin receptor agonist selexipag. We believe that the outpatient transition from injectable to oral or inhaled modalities is safely feasible for selected patients and offers a valuable alternative that expands the therapeutic spectrum for PAH.
Author Block: L. M. Kimmig, R. Bag; Section of Pulmonary and Critical Care Medicine, The University of Chicago, Chicago, IL, United States.
Introduction
Treatment modalities for World Health Organization (WHO) Group 1 pulmonary arterial hypertension (PAH) frequently include prostanoids. The drug delivery for medications of this class of medication was cumbersome and limited to continuous intravenous (IV) or subcutaneous infusion until recently. Inhaled and oral prostacyclin analogues and an oral prostacyclin receptor agonist have become available. We report the case of the successful ambulatory transition from IV treprostinil to oral selexipag in a patient at our Pulmonary Hypertension (PH) Center.
Case Report
A 62 year-old female with WHO Group 1 idiopathic PAH was followed in our PH Center and managed with tadalafil 40 mg daily, ambrisentan 5 mg daily, and treprostinil 104 ng/kg/min by continuous intravenous infusion. The patient expressed interest in transitioning away from injectable prostanoid therapy. She had been on IV treprostinil for 126 months prior to transition, including 111 months at her current rate. Over the course of 71 days, the patients IV treprostinil was decreased every 1-2 weeks as her selexipag was up-titrated to 1,600 mg twice daily. The patient was followed with regular phone calls during this time. The patient’s ambrisentan was also increased to 10 mg daily. The patient tolerated the transition well and her symptoms corresponded to WHO Functional Class 2 both before and after transition. Her 6-minute walk distance increased slightly from 1,493 feet to 1,506 feet. NT-proBNP decreased from 780 pg/ml to 438 pg/ml. On right heart catheterization, her pulmonary artery pressure decreased from 70/37 mmHg (mean 48 mmHg) to 52/28 mmHg (mean 36 mmHg). Cardiac output decreased slightly from 6.5 l/min to 5.7 l/min and PVR decreased from 5.4 Wood units to 4.9 Wood units. The patient reported diarrhea and mild jaw pain as side effects of her new therapy regimen after transition. She has not been hospitalized at our institution since her transition.
Discussion
Transitioning from injectable prostanoids to inhaled or oral formulations has previously been described. In the published literature, patients have typically been admitted to the hospital for the transition. We describe the successful outpatient transition from the intravenous prostacyclin analogue treprostinil to the oral prostacyclin receptor agonist selexipag. We believe that the outpatient transition from injectable to oral or inhaled modalities is safely feasible for selected patients and offers a valuable alternative that expands the therapeutic spectrum for PAH.
|
Home
|
Inbox
|
Search
|