Inpatient Initiation of Oral Treprostinil in an Academic Medical System
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ORIGINAL ARTICLE
Inpatient Initiation of Oral Treprostinil in an Academic Medical System Benjamin Hohlfelder 1
&
Adriano R. Tonelli 2 & Gustavo A. Heresi 2 & Nancy Bair 2 & Franck F. Rahaghi 3 & Seth R. Bauer 1
Published online: 19 May 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose Clinicians may transition patients on parenteral or inhaled prostacyclins to oral treprostinil for ease of use or to avoid adverse effects related to parenteral therapy. However, few data are available to guide these transitions in inpatients. The purpose of this analysis is to describe the inpatient initiation of oral treprostinil at an academic medical system. Methods This is a retrospective cohort analysis of patients newly initiated on oral treprostinil at Cleveland Clinic Heath System from 2015 to 2017. Demographic information regarding pulmonary arterial hypertension (PAH) history and previous PAH therapies were recorded. Outcomes evaluated included doses of oral treprostinil utilized, adverse effects related to therapy, and measures of clinical and functional status before and after the initiation of oral treprostinil. Results Overall, 29 patients were prescribed oral treprostinil, of which 15 patients were included in the analysis. Common reasons for initiation of oral treprostinil included disease progression (6, 40%) and patient desire (4, 25%). The median duration of transition/initiation of oral treprostinil was 4 days (range, 3–11 days). Median daily dose of oral treprostinil on day 1 of initiation was 2 mg (0.25–4 mg). By day 7, median daily dose was 15 mg (0.75–27.75 mg). Common adverse effects related to therapy were gastrointestinal (7, 47%) and headache (4, 27%). No patients required discontinuation of oral treprostinil due to adverse effects within 90 days of initiation. Conclusion Inpatient initiation/transition to oral treprostinil was relatively well tolerated. Future studies should evaluate clinical outcomes surrounding the transitioning to oral treprostinil. Keywords Pulmonary hypertension . Pulmonary arterial hypertension . Prostacyclins . Treprostinil
Introduction Prostacyclins are frequently used for the treatment of patients with advanced stages of pulmonary arterial hypertension (PAH) [1]. Available routes of administration of prostacyclins include intravenous (IV), subcutaneous (SQ), inhalation, and oral [2]. Parenteral prostacyclins (IV and SQ) have been shown to increase exercise capacity, decrease symptoms of PAH, and improve hemodynamic function [3]. Compared
* Benjamin Hohlfelder [email protected] 1
Department of Pharmacy, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44095, USA
2
Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
3
Department of Pulmonary and Critical Care Medicine, Cleveland Clinic Floirda, Weston, FL, USA
with placebo, IV epoprostenol has demonstrated improved survival at 12 weeks [4]. In light of these data, parenteral prostacyclins are suggested for PAH patients with World Health Organization (WHO) functional Class
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