A profile on inhaled treprostinil for pulmonary hypertension

INTRODUCTION: Pulmonary hypertension (PH) remains a progressive and life-threatening disease despite advances in therapies targeting multiple signaling pathways. Prostacyclin analogues play a central role in treatment; however, systemic formulations can be limited by treatment burden and systemic adverse effects. Inhaled treprostinil has emerged as an important prostacyclin-pathway therapy that allows targeted pulmonary artery vasodilation while minimizing systemic exposure, with relevance for pulmonary arterial hypertension (PAH) and PH associated with interstitial lung disease (PH-ILD). AREAS COVERED: This review provides a comprehensive overview of the pharmacology, pharmacokinetics, and clinical development of inhaled treprostinil across both currently available and investigational formulations. All major clinical trials are examined, including pivotal early Phase I - II investigations. We discuss all commercially available and emerging delivery platforms including nebulized, dry-powder, liposomal, and prodrug formulations. In addition, the review addresses safety, real-world utilization, regulatory status, and the evolving therapeutic and commercial landscape of inhaled prostacyclin therapy. EXPERT OPINION: Inhaled treprostinil has become a key treatment option in PH-ILD and PAH management. Continued development of longer-acting formulations and improved delivery systems may enhance adherence and expand its clinical role. Emerging evidence suggesting potential antifibrotic effects raises the possibility that inhaled treprostinil could influence disease progression in pulmonary fibrosis, potentially broadening its therapeutic applications in the coming years.