Key result
Intensive parenteral treprostinil therapy enabled 60.0% of high-risk pulmonary arterial hypertension patients to achieve hemodynamic targets and successfully transition to oral selexipag.
Why the study?
To evaluate the progress of intensive targeted therapy in high-risk PAH patients, focusing on setting an appropriate hemodynamic target of PVR <=4 WU and mPAP <=40 mmHg.
Does intensive parenteral treprostinil therapy followed by transition to oral selexipag improve hemodynamic parameters in patients with high-risk pulmonary arterial hypertension?
Observational (n=12)
No
Does intensive parenteral treprostinil therapy followed by transition to oral selexipag improve hemodynamic parameters in patients with high-risk pulmonary arterial hypertension?
Intensive parenteral treprostinil therapy can successfully lower pulmonary vascular resistance and mean pulmonary arterial pressure to target levels in high-risk PAH patients, allowing for a safe transition to oral selexipag.
Should not yet change practice in high-risk PAH; leaves open whether PVR/mPAP targets enable safe transition to oral selexipag.
Background: This study aimed to evaluate the progress of treatment with intensive targeted therapy in high-risk pulmonary arterial hypertension (PAH) patients and focused on setting an appropriate hemodynamic target of pulmonary vascular resistance (PVR) ≤4 Wood units (WU) and mean pulmonary arterial pressure (mPAP) ≤ 40 mmHg. Methods: We retrospectively evaluated high-risk PAH patients who were administered treprostinil at a single tertiary pulmonary hypertension center between January 2020 and December 2022. Echocardiography, right heart catheterization, 6-minute walk distance (6MWD), and blood tests were obtained 6 and 12 months after the initiation of parenteral treprostinil administration. Results: Twelve patients (1 male and 11 female; median age, 47.0 years [interquartile range, 33.8-49.8 years]) were included. Five of the 12 patients had 6- and 12-month follow-up data. The median PVR decreased by 22.9% at 6 months and 50.6% at 12 months compared to baseline. The median mPAP decreased by 24.6% at 6 months and 29.8% at 12 months. Importantly, the 6MWD showed a significant improvement of 55.7%, and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels demonstrated a notable decrease of 16.0%, reflecting substantial enhancements in patients' functional status and heart health. Three of these 5 patients reached the hemodynamic target by 12 months and successfully transitioned from parenteral treprostinil to oral selexipag. Conclusions: This study showed that 3 of 5 patients (60.0%) with high-risk PAH reached PVR ≤ 4 WU and/or mPAP ≤ 40 mmHg by receiving intensive parenteral treprostinil therapy with significant improvements in 6MWD and NT-proBNP levels, and successfully transitioned to oral selexipag. We proposed that transition strategies from parenteral treprostinil to selexipag aiming at hemodynamic targets.
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Yeo et al. (2025) conducted an observational in High-risk pulmonary arterial hypertension (n=12). Parenteral treprostinil vs. Baseline was evaluated on Achievement of pulmonary vascular resistance ≤4 Wood units and/or mean pulmonary arterial pressure ≤40 mmHg. Intensive parenteral treprostinil therapy enabled 60.0% of high-risk pulmonary arterial hypertension patients to achieve hemodynamic targets and successfully transition to oral selexipag.
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