Treprostinil Inhalation Powder for Pulmonary Arterial Hypertension: Evidence and Clinical Positioning Among Inhaled Formulations

OBJECTIVE: To describe treprostinil inhalation powder (Yutrepia) and evaluate its role among inhaled treprostinil formulations for pulmonary arterial hypertension (PAH). DATA SOURCES: PubMed/MEDLINE was searched from inception through September 10, 2026 using terms related to PAH, treprostinil, inhaled treprostinil, dry powder inhalers, Tyvaso, Tyvaso dry powder inhalation (DPI), Yutrepia, and LIQ861. The search identified 258 records; reference lists and prescribing information were also reviewed. STUDY SELECTION AND DATA EXTRACTION: Twelve original reports addressing efficacy, safety, pharmacokinetics, transition, or administration were included. One author performed initial screening and study selection, and a second author independently verified inclusion and exclusion decisions. DATA SYNTHESIS: TRIUMPH I demonstrated a placebo-corrected median improvement of 20 m in peak 6MWD at week 12 with nebulized treprostinil added to oral PAH therapy. BREEZE supported transition feasibility, comparable exposure, and greater device satisfaction after transition to treprostinil DPI; INSPIRE supported Yutrepia tolerability and acceptability, but its exploratory efficacy outcomes were descriptive. No head-to-head trial has established superiority.Relevance to Patient Care and Clinical Practice in Comparison With Existing Drugs:Both dry powder formulations reduce nebulizer equipment burden, but current evidence does not establish greater efficacy, safety, adherence, or convenience for one dry powder product over the other. Selection should consider disease risk, device technique, tolerability, treatment burden, cost, coverage, and access. CONCLUSIONS: Yutrepia expands inhaled prostacyclin options for PAH. Selection should be individualized, and inhaled therapy should not be considered equivalent to parenteral prostacyclin when parenteral treatment is clinically indicated.