Key result
Transitions between infused and oral prostacyclin pathway agents in pulmonary arterial hypertension require careful, individualized titration strategies to manage side effects and avoid clinical worsening.
Why the study?
Patients with pulmonary arterial hypertension are transitioned between prostacyclin pathway agents with increasing frequency, but clinical guidance is especially lacking for transitions involving newer oral agents such as selexipag and oral treprostinil.
What are the key considerations when transitioning patients with pulmonary arterial hypertension between parenteral and oral prostacyclin pathway agents?
Case Report (n=3)
What are the key considerations when transitioning patients with pulmonary arterial hypertension between parenteral and oral prostacyclin pathway agents?
Careful titration protocols and patient selection are critical when transitioning PAH patients between parenteral and oral prostacyclin pathway agents to avoid decompensation.
May support individualized titration in PAH prostacyclin transitions to limit worsening; leaves open need for prospective trials.
Prostacyclin pathway agents are a critical treatment for patients with pulmonary arterial hypertension. Seven prostacyclin pathway agents are available, including agents administered by parenteral infusion, by inhalation, and orally. Pulmonary arterial hypertension patients are now transitioned from one prostacyclin pathway agent to another with increasing frequency. Such transitions require careful downtitration and uptitration to avoid decompensation from rapid withdrawal and to achieve a patient's optimal dose based on efficacy and tolerability. Clinical guidance is especially lacking for transitions involving the newer, oral prostacyclin pathway agents; specifically, selexipag and oral treprostinil. We present three case reports of patients with pulmonary arterial hypertension who underwent one or more transition between parenteral and oral prostacyclin pathway agents, including some transitions that were successful and some that were not. These cases illustrate key considerations, such as titration protocols, patient selection, side effect management, and pharmacokinetics.
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Sargent et al. (2020) conducted a case report in Pulmonary arterial hypertension (n=3). Transition between infused and oral prostacyclin pathway agents was evaluated. Transitions between infused and oral prostacyclin pathway agents in pulmonary arterial hypertension require careful, individualized titration strategies to manage side effects and avoid clinical worsening.
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